Termination of Pregnancy Flashcards
Abortion Definition
Removal of fetus or embryo from uterus before stage of viability
Percentage of pregnancies in US that are unintended
45%
Proportion of pregnancies that end in abortion
1/5
Proportion of women in the US that will have an abortion by age 45
1/4
Proportion of women aged 15-44 worldwide has had at least one abortion
1/4
Percent of abortions that occur at 8 weeks pregnancy or earlier
66%
Percent of abortions that occured in first 12 weeks of pregnancy
88%
Requirements in North Carolina to have an abortion
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
At less than 10 weeks, for an induced abortion, what option is there?
Medication (misoprostoal and Mifepristone)
Aspiration (surgical) - D&C
At 10-12 weeks, for an induced abortion, what option is there?
Aspiration (surgical)
At 12-14 weeks, for an induced abortion, what option is there?
Cervical preparation usually requiring aspiration
At >14 weeks, for an induced abortion, what option is there?
Cervical preparation
Dilation and evacuation
At less than 10 weeks, for an spontaneous abortion, what option is there?
Medication (Misoprostol)
Aspiration (surgical) - D&C
At 10-12 weeks, for an spontaneous abortion, what option is there?
Medication (misoprostol)
Aspiration
At 12-14 weeks, for an spontaneous abortion, what option is there?
Cervical preparation usually requiring aspiration
At >14 weeks, for an spontaneous abortion, what option is there?
Cervical preparation
Dilation and evacuation
Abortion medications
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
Mifepristone
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
Progesterone
Pro-gestation
maintain pregnancy
Decreases myometrial excitability
Withdrawal of progesterone support in early pregnancy results in uterine contractions
Misoprostol
Synthetic prostaglandin
Absorbed through mucus membranes
Can be administered by - oral, buccal, vaginal, rectal
Actions - uterotonic (uterine contractions), cervical priming (cervical softening)
Cervical preparation
Dilation
medical (misoprostol)
Dilators - synthetic (dilapan) and natural (seaweed) - place in cervix 4 to 48 hours before procedure
How do dilators work
Swell to 3-4X dry size
Exert direct radial pressure
Release prostaglandins
Up to 14 weeks evacuation
Manual vacuum aspiration
Electric vacuum aspiration
Greater than 14 weeks evacuation
Dilation and evacuation
Labor induction abortion (LIA)
Percent of D&E abortion evacuations after 14 weeks
96%
Percent of LIA abortion evacuations after 14 weeks
4%
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?
Cervical preparation and aspiration
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
Telehealth appointment
