Week 4: pregnancy termination

Question 1

demographics of women undergoing abortion in us

Answer 1

• ~50% of pregnancies are unintended and 40% end in induced abortion
• 1/3 women have had abortion by age 45
• tend to be women in their 20s in lower socioeconomic status

Question 2

methods for first trimester abortions: medical

Answer 2

1. medications
   - Mifepristone (RU 486): derivative of norethindrone. Competitive antagonist of progesterone. withdrawal of progesterone causes expulsion of embryo.
   - Misoprostol: prostaglandin E1 analogue. Stimulates uterine contractions, softens and ripens cervix. Side effects: diarrhea, vomitting, fever.
2. side effects
   - vaginal bleeding
   - uterine cramping
3. complications
   - failure 2-5%
   - excessive bleeding
   - rare: undiagnosed ectopic, infection, teratogenic effects if pregnancy continues, death

Question 3

methods for first trimester abortions: surgical

Answer 3

1. methods
   - manual vacuum aspiration: syringe that creates suction. up to 12 weeks
   - electric vacuum aspiration: up to 16 weeks of pregnancy. suction catheter removes products of conception.
2. Pain management
   - local anesthetic: para cervical block
   - verbal support, NSAIDs, PO narcotics, PO anxiolytics, IV narcotics, conscious or moderate sedation
3. Side effects
   - vaginal bleeding, uterine cramping,
4. Complications
   - very rare. Incomplete evacuation, uterine/cervical injury, injury to bowel, bladder, blood vessels. Infection, hemorrhage, vasovagal rxn.

Question 4

2nd trimester abortion options: surgical

Answer 4

1. dilation and evacuation D&E
   - most common surgical method. 1-2 days of pre-op prep with osmotic dilators, chemical ripening agents: misoprostol, laminaria (mechanical)
   - predictable timing and short procedure. Can be done in outpatient setting.

Question 5

2nd trimester abortion: medical

Answer 5

1. misoprostol-most common method of second trimester medical abortion
   - time varies, can be 12-16 hrs, with misoprostol administered every 3-6 hours.
   - requires hospital admission
2. contradindications
   - severe anemia
   - known coagulopathy, or anti coagulation therapy
   - allergy to misoprostol