Spontaneous and Induced Abortion 3

Question 1

What are the medical agents used for abortion during the first trimester?

Answer 1

• Mifepristone - antiprogestin
• Misoprostol - prostaglandin analogue

Question 2

What is the FDA approved regimen for medical abortion? What is the commonly used regimen?

Answer 2

• FDA-approved
  
  • 600 mg Mifepristone
  • 400 mcg Misoprostol
  • 92% efficacy
• Commonly used
  
  • 200 mg Mifepristone
  • 800 mcg Misoprostol
  • 96-98% efficacy
  • less expensive

Question 3

What are some other regimens to induce abortion aside from Mifepristone/Misoprostol?

Answer 3

• Misoprostol 800 mcg vaginally
• Repeat dose on day 3 if indicated

Question 4

What are some indications for clinician follow-up after a medical abortion?

Answer 4

• Heavy bleeding with dizziness, lightheadedness
• Worsening pain not relieved with medication
• Flu-like symptoms lasting >24 hrs
• Fever or chills
• Syncope
• Any questions

Question 5

When is medical abortion contraindicated?

Answer 5

• Confirmed or suspected ectopic pregnancy
• IUD in place
• Long-term corticosteroid use
• Hemorrhagic disorders or inherited porphyrias
• Concurrent anticoagulant use
• Chronic adrenal failure
• Allergy to mifepristone, misoprostol, or other prostaglandin

Question 6

What are the advantages vs. risks of medical abortion?

Answer 6

• Advantages
  
  • avoids instrumentation
  • abortion within 24 hours
  • can use oral pain medication
  • part of the process is at home
• Risks
  
  • retained products of conception
  • infection and bleeding

Question 7

What are the advantages vs. risks of vacuum aspiration?

Answer 7

• Advantages
  
  • can be done in one visit
  • procedure takes 5-10 minutes
  • may be used in early pregnancy
  • anesthesia/sedation is available
• Risks
  
  • uterine perforation (1/1000)
  • retained products of conception
  • infection
  • bleeding

Question 8

What is the appropriate follow-up after a medical abortion?

Answer 8

• Assess completion of abortion by
  
  • patient history
  • serial HCGs or sonography
  • speculum and/or bimanual exam as indicated
• Documentation of missed follow-up
• If incomplete or unsuccessful, MVA can be used for retained POC

Question 9

What are methods of abortion in the second trimester?

Answer 9

• General categories the same, but methods vary because of larger fetus and changing uterine responsiveness to medications
• 90% of second trimester abortions in the US accomplished surgically
• Both medical and surgical abortion safer for mother throughout second trimester than continuation of pregnancy
• D and E procedure
  
  • cervical preparation
    
    • osmotic dilators
    • laminaria leads to prostaglanding productionand dilation
    • misoprostol can be added for certain patients
  • uterine evacuation