Reproductive choices

Question 1

Unplanned pregnancy epidemiology

Answer 1

80mil/y
45 m terminated compared to 135 m births
47k women die because of unsafe abortion

Question 2

Unsafe abortion

Answer 2

restrictive abortion laws
untrained providers
unsafe abortion
high abortion mortality
death dramatically decreased after legalization

Question 3

Moderately effective contraception

Answer 3

6-12/100/y
injectable
pills
patch
ring
diaphragm

Question 4

Less effective contraception

Answer 4

18 or more/100/y
male, female condoms
sponge
withdrawal
spermicides
fertility-awareness

Question 5

Lifetime risk of abortion

Answer 5

Canada: 31% of women have an abortion by age 45

Question 6

Early surgical method of abortion

Answer 6

suction/aspiration (prev. dilation + curettage)
local anesthetics
fastest way to rule out ectopic pregnancy
controlled, single visit

Question 7

> 14 w surgical method of abortion

Answer 7

dilation and evacuation
~5% of all abortions
1/2 are fetal indications
cervical prep essential - osmotic dilators, misoprostol
BC: 2 days if 14-20 wks, 3d if >20
induction of fetal demise over 18 wks
controlled +/- GA
quick, no labour

Question 8

> 14 w medication abortion

Answer 8

>16 w but usually >18 w
fetal demise induced prior to induction - KCl, digoxin
Misoprostol
Intact
No surgery

Question 9

Abortion complication rates

Answer 9

Complication rate 0.68%
retained products of conception 0.38%
hemorrhage 0.08
infection 0.03

Question 10

Early medication abortion

Answer 10

mifepristone (not yet available in Canada) and methotrexate
- fetal demise
- methotrexate: teratogenic; up to 7 wk LMP only
Misoprostol
- PG antagonist
- cause expulsion of pregnancy
- can be used alone (very early) to cause termination by itself: but only ~60% effective
Private
no surgery

Question 11

Safety of abortion

Answer 11

Illegal - 1/280 mortality
Legal - 1/150 000 mortality
further fertility after an induced abortion - similar to that after a miscarriage at same gestation
No association between abortion and breast ca
1st trimester abortion poses no risk of: infertility, ectopic pregnancy, miscarriage, birth defect, preterm/lowBW at delivery

Question 12

Abortion complication rates

Answer 12

Complication rate 0.68%
retained products of conception 0.38%
hemorrhage 0.08
infection 0.03

Question 13

CMA policy on abortion

Answer 13

No discrimination against doctors who choose not to perform/assist abortions
Respect for right of personal decisions stressed
No discrimination against doctors who provide abortion services
Early diagnosis of pregnancy/determination of appropriate management encouraged
Patient provided with option of full and immediate counselling services in the event of unwanted pregnancy
No delay in provision of abortion services

Question 14

Ethical issues in refusal to treat - CPS BC

Answer 14

Responsibilities to the patient:

• inform patient when personal values would influence recommendations
• do not discriminate