termination Flashcards

1
Q

frequency of abortion

A

19% of unwanted pregnancies end in abortion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

how many abortions are after the first trimester

A

9%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Ca limit for abortions

A

In California, legal limit of 2nd trimester abortion is 23 weeks 6 days.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

1992 Planned Parenthood v. Casey

A

gave states the right to enact restrictions that do not create an “undue burden” for women seeking abortion

Parental consent or parental notification laws

Public funds for abortions for income qualifying women

No federal funding for abortions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

state-mandated counseling

A

mandated counseling for abortion

long term mental health consequences in 8 states

purported link between abortion and breast cancer (5)

counseling the the fetuses ability to feel pain in (13)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

AB-154

A

law that allows CNMS, nPs. and PAs to provide 1st trimester abortion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what % result in complications

A

The overall abortion complication rate is lower than those for wisdom tooth removal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

if you don’t have ULS

A

Lemon 5-6 weeks,
medium 7-8 weeks grapefruit 9-10 weeks or fungal height
after 12 weeks uterus rises out

of pelvis at 20 weeks reaches umbilicus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

how can MSD be used to determine GA

A

GA (days)= MSD+30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

non viable pregnancy

A

empty GS>25 mm in diameter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

A normal early GS can be characterized by the FEEDS mnemonic, although meeting all criteria
does not exclude the possibility of ectopic pregnancy

what is FEEDS

A

F - Fundal - in mid or upper uterus

E - Ellpitical or round shape in 2 views

E - Eccentric to the endometrial stripe

D - Decidual reaction (surrounded by a thickened choriodecidual reaction; appears like a fluffy white cloud or ring surrounding the sac

S - Size > 4 mm (soft criteria)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

yolk sac indicates

A

probably intrauterine

typically 5 1/2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

embryo appears at

what is growth like from there and how is it measured

A

6 weeks and grows 1mm per day until 12-24 weeks

after that used BPD (fetal biparieal diameter)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

cardiac activity

A

6.5 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

MAB

medical abortion

A

medication abortion

10 weeks 0 days gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

surgical abortion is an option for

A

<13 weeks 6 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

risks of MAB

A

Similar to a first trimester surgical abortion, particularly:

Endometritis, infection, hemorrhage

No risk of cervical injury or uterine perforation

Increase in teratogenic risk to an ongoing pregnancy

May still need surgical aspiration to complete the termination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

A safe and effective way to terminate a pregnancy up to ___ days gestation

A

A safe and effective way to terminate a pregnancy up to 70 days gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is mifepristone approved for

A

The US Food and Drug Administration (FDA) has approved mifepristone for the termination of an intrauterine pregnancy up to 49d gestation.
2. Beyond this 49d gestation is considered off-label

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

CI to MAB

A
  1. Ectopic pregnancy
  2. Intrauterine device in place
  3. Patients with chronic adrenal failure or who are on concurrent long-term corticosteroid therapy
  4. History of hemorrhagic disorders, are on anticoagulant therapy, or on any medications that interfere with hemostasis
  5. History of porphyrias
  6. Lack of ability to comply with the regimen or access care in case of complication
  7. No data for women with chronic medical conditions (HTN, DM, cardiovascular, hepatic or renal disease) or cigarette smokers – labeling of mifepristone advises caution in women with these conditions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

requirement for prescribing Mifepristone

A

The FDA requires mifepristone by prescribed* only by physicians (not NPs, PAs, or nurse midwives) who can:

  1. Make an accurate assessment of gestational age
  2. Diagnose ectopic pregnancy
  3. Provide surgical intervention in cases of severe bleeding or incomplete abortion OR make provisions to provide care through another provider
  4. Assure patient access to medical facilities equipped to perform blood transfusions and resuscitation
  5. *a physician may delegate another health professional to administer the drug
22
Q

DI of mifepristone

A
  1. Mifepristone is metabolized by cytochrome P450 3A4 (CYP3A4) and can theoretically interact with agents that impact CYP3A4 function.
  2. No specific food or drug interactions with a single dose of mifepristone have been reported.
23
Q

requirements after prescribing

A

a. Must sign a prescriber’s agreement with the manufacturer of mifepristone
b. Require that patients read the manufacturer’s Medication Guide and sign the Patient Agreement form
c. Report any ongoing pregnancy or serious events (eg hospitalization, infection, blood transfusion).

24
Q

Two regimens for MAB

A

Mifepristone 600mg orally, followed 48 hours later by misoprostol 400mcg orally. Both administered by a clinician

Alternative regimen, referred to as the evidenced-based regimen
preferred **

Mifepristone 200mg orally administered by a clinician, followed 24-72 hours later by misoprostol 800mcg buccal, administered by a healthcare provider or self-administered in a non-clinical setting

25
how does mifepristone work
It is a derivative of norethindrone (a synthetic progestin) that acts as an antiprogestin. It binds to the progesterone receptor with greater affinity than progesterone itself. However, the receptor does not activate, thus blocking the action of progesterone which is needed to establish and maintain placental attachment.
26
initial visit will involve
confirm GA counseling and informed consent STI testing blood typing/verification and administration of Rh immune globuline if needed although there id a debate over if this is really needed prophylactic anbx administration
27
prophylactic anbxs or MAB
azithro 500mg x1 day doxy 100mg x7days
28
follow up visit for MAB
Follow-up visit in approximately 2 weeks to confirm pregnancy was expelled – usually via history and pelvic exam or transvaginal ultrasound Provide contraception
29
first trimester abortion SE
Gastrointestinal discomfort: nausea, vomiting, diarrhea Abdominal pain Excessive vaginal bleeding Some women experience headaches, dizziness, or fatigue.
30
complications of MAB
``` Hemorrhage Infection Incomplete abortion Incomplete expulsion Ongoing pregnancy Unrecognized ectopic pregnancy ```
31
hemorrhage with MAB can result from
Can be related to uterine atony or retained products of conception For patients with excessive or prolonged bleeding, incomplete abortion should be excluded. Generally, blood loss is not severe enough to require therapy. In a large study, blood transfusion was required in only 0.05% of procedures.
32
tx for ectopic
methotrexate
33
hgb done before MAB
because low hgb can't have
34
how soon after using MAB can a pt get pregnant
10 days
35
types of surgical abortion
mechanical or manuel
36
complication rates of surgical abortion
Complication rate of 0-3% and efficacy rate of 98-99% takes 1 day
37
risk of surgical abortion
Similar to MABs Endometritis Life threatening infections are rare, but have occurred more often with surgical abortion Hemorrhage occurs at similar rates to MABs, but cause is usually related to cervical laceration or uterine injury due to instrumentation
38
indications
Very Early Abortion (VEA): from the time of positive pregnancy test up to 6 weeks Very Early Abortion (VEA): from the time of positive pregnancy test up to 6 weeks can do a diagnostic abortion
39
expectations after surgical abortion
Most women experience mild lower abdominal cramping for 2-4 days post-procedure Women should be informed that vaginal passage of small amounts of tissue and blood can be expected post-procedure
40
complications of surgical abortion
``` Hemorrhage May result from cervical or vaginal lacerations Uterine perforation Retained tissue Uterine atony Infection Incomplete abortion ```
41
f/u for surgical abortion
Routine follow-up recommended in 2-4 weeks
42
medications for discharge abortions
Discharge with medications (NSAIDs, methergine, doxycycline, contraception)
43
should abstain for intercourse for surgical abortion
Abstain from vaginal intercourse or tampon use x 2 weeks.
44
pts should be advised to return to clinic if pregnancy symptoms have not resolved within___ week or if not return to normal menses by ___ weeks post procedure
Return to clinic if pregnancy symptoms have not resolved within one week of procedure or if normal menses has not returned by 6 weeks post-procedure.
45
second trimester abortion
``` Preprocedure preparation Anesthesia and antibiotics Procedure (focusing on D&E) Possible use of uterotonics Assessment for retained products of conception ```
46
Diagnosis of EPL is confirmed by one of the following: (3)
1) US confirmation of an embryonic gestation or fetal demise in the uterus in conjunction with falling serial HCGs, 2) absence of previously seen IUP on US 3) Tissue exam confirming expulsion from uterus
47
medication management of early pregnancy loss (EPL)
with MAB medications Mife/Miso or Miso alone or Methotrexate (in settings of EPL vs ectopic) - need follow up ultrasound
48
other options for EPL (other than medication)
Aspiration in out patient or OR setting - usually no follow up required
49
ectopic tx
Treatment is usually methotrexate followed by serial HCGs.
50
ectopics usually present
In all patients presenting with first trimester bleeding, ectopic pregnancy should be considered. Ectopic pregnancies often present at 6-8 weeks gestation.