Termination of preg

Question 1

Mx options

Scenario 1 - unplanned preg 12/40 2nd to mirena migrating into abdomen

Scenario 2 - fetal anomaly 17/40 after T13 diagnosis

Scenario 3 - unplanned preg on warfarin for PE

Answer 1

• continue preg
• terminate preg
  D&E-recom<15, can do up to 24/40
  Medical - offer15-24, recom >24

medical - mife/miso
- mife 24-48/24 then miso
- in hospital/pain mx
- birthing not procedure
- pro - avoid GA/surgery
- con - can’t predict time, side effects, retained plac -> MROP

surgical - D&E
- day stay, under GA
- misoprostol pre-op
- USS guidance evacuation
- pro - definitive, timed
- con - cervical injury, hemorrhage…

• POC testing
• OPC F/U
• Preconception optimization of RFs

Question 2

Risk of warfarin to preg

Answer 2

Teratogenic
- miscarriage
- nasal and limb hypoplasia
- stippled cartilage
- CNS abnormalities