uninteded pregnancy/PID Flashcards
Elective abortion vs Therapeutic Abortion
Elective abortion
Interruption of pregnancy before viability at the request of the woman, but not for medical reasons
Also referred to as voluntary abortion
Therapeutic abortion
Termination of pregnancy before viability for medical indications
> 50% of all pregnancies in the United States are unintended
>
Unwanted, unplanned, or mis-timed pregnancies
Most do not end in elective abortion
As medical providers you should:
Aid in the prevention of an unintended pregnancy
Provide unbiased, medically accurate information regarding options for women with unintended pregnancy
Risk Factors for Unprotected Intercourse
Difficulty obtaining contraceptives
Less than a college education
Woman aged 20-24 years
Black race
Lack of social support
Depressive symptoms
History of intimate partner violence
Options for Unintended Pregnancy
Three options:
Give birth and raise the child
Give birth and place the baby for adoption
End the pregnancy with an induced abortion
Discussion of the 3 options:
Nonjudgmental manner
Impartial and medically accurate characterization of the options
Respect the rights and decision of the patient
Conscientious Refusal
Can be exercised by the medical provider
Not compelled to perform an act that violates his/her good judgment or personally held moral principles
Has to be consistent with good moral practices
Medical provider has 2 options:
Provide information
Financial and other assistance available to both her and the child
Availability of licensed or regulated adoption agencies if the patient chooses not to keep the child
Availability of safe, legal abortion services if she chooses not to continue the pregnancy
Identify resources where such information can be obtained
uninteded pregnancy
Raising the Child
Role of the medical provider:
Provide prenatal care
Provide resources for the mother and family during the pregnancy and with subsequent care of the infant
Local public health agencies
Medical resources
Financial resources
Social resources
Spiritual resources
unintended pregnancy
adoption
Voluntary placement of children is rare in the United States < 1%
Occurs through licensed private or state-run adoption agencies
Laws vary by states and can be complex
Who is likely to choose adoption?
White women
Unmarried
Women who expect little assistance with child care
Higher education levels
High career or educational aspirations
Current elective abortion Laws
41 STATES HAVE ABORTION BANS IN EFFECT WITH LIMITED EXCEPTIONS
Most include exceptions to preserve a pregnant person’s life or health
14states have a total abortion ban
27states have abortion bans based on gestational duration
7states ban abortion at or before 18 weeks’ gestation
20states ban abortion at some point after 18 weeks
9 STATES AND THE DISTRICT OF COLUMBIA DO NOT RESTRICT ABORTION BASED ON GESTATIONAL DURATION
1st trimester Medically Induced Abortion
1st trimester medical abortion
Preferred method in the 1st trimester
U.S. FDA approved regimen
Mifepristone (antiprogesterone) 600 mg PO followed by misoprostrol (prostaglandin E1 analog) 400 mcg PO
Infection after medical abortion is rare and prophylactic antibiotics are not indicated
Rh status of the mother must be known and RhoGAM administered if indicated
2nd trimester Medically Induced Abortion
2nd trimester medical abortion
Multiple regimens
Patients usually require admission to the hospital
Duration of the abortion is variable and blood loss may be more significant
Account for all fetal parts
Infection after medical abortion is rare and prophylactic antibiotics are not indicated
Rh status of the mother must be known and RhoGAM administered if indicated
Surgically Induced Abortion
1st trimester surgical methods
Vacuum aspiration
Dilation & Curettage
Require dilation of the cervix prior to the procedure
Perioperative antibiotics given to prevent upper genital tract infection
Equally effective
Similar complication rates
2nd trimester surgical methods
Same methods used as in the 1st trimester
Account for all fetal parts
Perioperative antibiotics given to prevent upper genital tract infections
elective abortion
Consequences
Recognize that elective abortion can have lasting consequences:
Physical Complications
Hemorrhaging, infection, cervical laceration, perforation of the uterus, uterine rupture, endotoxic shock, death
May require hysterectomy
Psychological Problems
Depression and despair are common after abortion
Women who abort have asix times higher rate of suicidethan those who carry their babies to term
Future Risks
Women who abort are more likely to experiencefuture ectopic pregnancy, infertility, stillbirth, miscarriage, and premature birth
Pelvic Inflammatory Disease
general
Acute upper genital tract infection in women that affects theuterus, fallopian tube,ovaries, and possibly the adjacent pelvic organs
Often ascends from lower genital tract infection
Epidemiology
>1 million cases per year in the United States (CDC)
More common in women < 35 years old
Most cases occur in 15-25 year old females
Risk factors:
Unprotected sexual intercourse
Multiple sexual partners
History of STIs
Presence ofbacterial vaginosis
PID
Etiology
STIs (85%):
Chlamydia trachomatis
Most common bacterialSTI
Neisseria gonorrhoeae
Mycoplasma genitalium
Trichomonas vaginalis
Other isolatedbacteria:
Gardnerella vaginalis
Cytomegalovirus
Streptococcusagalactiae
Enteric gram-negative bacilli
Ureaplasmaspecies
Instrumentation or trauma-related pelvic infection
PID
patho of normal pelvic protection
Normal vaginal flora is predominantly?
Endocervical canal serves as a barrier between the sterile upper genital tract and the vaginal canal, which contains differentbacteria
Normal vaginal flora is predominantlyLactobacillus species mixed with a low amount of potentially harmfulbacteria
PID
Patho of pelvic infection
Infection fromSTIor vaginal microorganisms (may be asymptomatic) → disruption of mucosal barrier → spread of infection to upper genital tract (usually symptomatic) → spread of infection to peritoneal cavity → inflammatory damage resulting in scarring, adhesions, and partial or total obstruction of the Fallopian tubes
Infection Sites
Uterus/endometrium:endometritis
Fallopian tube: salpingitis
Ovaries:oophoritis
Surrounding area/peritoneum:peritonitis
Increased risk of PID from lower genital tractbacteriaoccurs:
Duringmenses
With an intrauterine device (IUD)
PID
Clin Man
acute / chronic/ subclinical
Acute PID (duration ≤ 30 days):
Fever
Nausea and/orvomiting
Lower abdominal/pelvicpain
Purulent vaginal discharge
Abnormal uterine bleeding
Dyspareunia -painful sex
Dysuria
Chronic PID (duration > 30 days):
Milder symptoms than acute presentation
Higher association with complications
Subclinical PID:
Signs and symptoms can be absent or mild (Chlamydia trachomatis or Mycoplasma genitalium)
Somepatientspresent with infertility
Adhesions
Distal fallopian tube occlusion
PID
PE Findings
Physical exam
Mucopurulent cervical discharge
Cervical friability
Cervical motion tenderness → Chandelier sign
Unpleasant sensation or response elicited on pelvic examination with movement of the cervix by the medical provider
Guarding or rebound tenderness
Uterine and/or adnexal tenderness
Adnexalmass
PID
imaging
Imaging:
Transvaginal ultrasound
Obtained if clinical and laboratory findings are inconclusive or complications suspected
May show thickenedfallopian tube, free pelvic fluid, or indistinct endometrial borders
In cases of tubo-ovarianabscess: complex adnexal collection with multiple fluid levels
PID
complications
Chronic pain
Tubo-ovarianabscess:
Presents as an adnexalmass
Ectopicpregnancy (70,000 cases – CDC)
Hydrosalpinx
End portion of the fallopian tube becomes fluid-filled and swollen
Infertility (100,000 women – CDC)
Fitz-Hugh-Curtis syndrome (peri-hepatitis orinflammationof thelivercapsuleand peritoneal surfaces)
