Termination of Pregnancy

Question 1

Abortion Definition

Answer 1

Removal of fetus or embryo from uterus before stage of viability

Question 2

Percentage of pregnancies in US that are unintended

Answer 2

45%

Question 3

Proportion of pregnancies that end in abortion

Answer 3

1/5

Question 4

Proportion of women in the US that will have an abortion by age 45

Answer 4

1/4

Question 5

Proportion of women aged 15-44 worldwide has had at least one abortion

Answer 5

1/4

Question 6

Percent of abortions that occur at 8 weeks pregnancy or earlier

Answer 6

66%

Question 7

Percent of abortions that occured in first 12 weeks of pregnancy

Answer 7

88%

Question 8

Requirements in North Carolina to have an abortion

Answer 8

72 hour waiting period
State mandated counseling
Only MDs can provide care
Parental consent for teens (parent or grandparent if they have lived with them for 6 months or longer, judicial bypass, emancipated)
Face to face visit
20 week ban

Question 9

At less than 10 weeks, for an induced abortion, what option is there?

Answer 9

Medication (misoprostoal and Mifepristone)
Aspiration (surgical) - D&C

Question 10

At 10-12 weeks, for an induced abortion, what option is there?

Answer 10

Aspiration (surgical)

Question 11

At 12-14 weeks, for an induced abortion, what option is there?

Answer 11

Cervical preparation usually requiring aspiration

Question 12

At >14 weeks, for an induced abortion, what option is there?

Answer 12

Cervical preparation
Dilation and evacuation

Question 13

At less than 10 weeks, for an spontaneous abortion, what option is there?

Answer 13

Medication (Misoprostol)
Aspiration (surgical) - D&C

Question 14

At 10-12 weeks, for an spontaneous abortion, what option is there?

Answer 14

Medication (misoprostol)
Aspiration

Question 15

At 12-14 weeks, for an spontaneous abortion, what option is there?

Answer 15

Cervical preparation usually requiring aspiration

Question 16

At >14 weeks, for an spontaneous abortion, what option is there?

Answer 16

Cervical preparation
Dilation and evacuation

Question 17

Abortion medications

Answer 17

Day 1 - Mifepristone 200 mg
Day 1-3 - Misoprostol 800 micrograms
Prophylactic medications - antibiotics, pain medications, antiemetics (to prevent nausea)
Contraindication - Porphyria or chronic steroid use, coagulopathy or clinically significant anemia, inability to follow up or access emergency care

Question 18

Mifepristone

Answer 18

Abortion medication
Binds progesterone receptors
Affinity greater than progesterone
Does not activate receptor
Antiprogestin: decidual necrosis, separation of trophoblast cells from the decidua basalis, induces uterine contractility, decreases human chorionic gonadotropin secretion into the maternal system, softens cervix

Question 19

Progesterone

Answer 19

Pro-gestation
maintain pregnancy
Decreases myometrial excitability
Withdrawal of progesterone support in early pregnancy results in uterine contractions

Question 20

Misoprostol

Answer 20

Synthetic prostaglandin
Absorbed through mucus membranes
Can be administered by - oral, buccal, vaginal, rectal
Actions - uterotonic (uterine contractions), cervical priming (cervical softening)

Question 21

Cervical preparation

Answer 21

Dilation
medical (misoprostol)
Dilators - synthetic (dilapan) and natural (seaweed) - place in cervix 4 to 48 hours before procedure

Question 22

How do dilators work

Answer 22

Swell to 3-4X dry size
Exert direct radial pressure
Release prostaglandins

Question 23

Up to 14 weeks evacuation

Answer 23

Manual vacuum aspiration
Electric vacuum aspiration

Question 24

Greater than 14 weeks evacuation

Answer 24

Dilation and evacuation
Labor induction abortion (LIA)

Question 25

Percent of D&E abortion evacuations after 14 weeks

Answer 25

96%

Question 26

Percent of LIA abortion evacuations after 14 weeks

Answer 26

4%

Question 27

You are a prenatal genetic counselor seeing a patient at 12 weeks 5 days gestation that is
planning a termination of pregnancy. What is the most likely procedural method that will
be used?

Answer 27

Cervical preparation and aspiration

Question 28

As of right now, if someone is looking to have an abortion in the state of North Carolina,
which is not a criteria to be able to have one

Answer 28

Telehealth appointment