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Flashcards in Abortion Deck (22)
1

What % of women have had an induced abortion?

40%

2

What is the safest and most common time to have an abortion?

<8 weeks=lowest risk of death. Most common is first trimester

3

What is safer? Abortion or pregnancy?

ABORTION! at all stages of preg

4

What is the strongest risk factor for abortion related mortality?

Gestational age

5

How is an early pregnancy abortion completed, how long can it be used, and how does it work?

Via vacuum aspiration which can be used up to 12-13 week gestation. It is inserted through the cervix and tissue is removed.

6

What must the tissue removed contain?

The tissue removed must be examined and should contain: 1. endometrium (decidua, glands, vessels, hemorrhage) 2. placenta (dep on gestational age, villi, cord, yolk sac) 3. embryo/fetus.

7

How do you perform a tissue inspection?

1. Strain and rinse tissue 2. Place in clear container of water 3. Hold over strong light 4. IDENTIFY TROPHOBLASTIC TISSUE 5. Tissue volume must correlate with gestational age

8

What is recognizable tissue at 5-7wks

Decidua (lines uterus during preg) and trophoblastic villi

9

What is recognizable tissue at 8-9wks

Decidua, placenta (formally trophoblastic tissue), embryo/fetus

10

What is recognizable tissue at 9-12wks

Decidua, placenta (opaque, dense, pink), fetal parts

11

What are the 3 medication regimens one can use to induce abortion?

1. Mifepristone and misoprostol (FDA approved) 2. Methotrexate and misoprostol 3. Misoprostol alone

12

What is the MOA of mifepristone? How effective is it and is it FDA approved?

Binds progesterone receptor with high affinity causing abortion (competitive inhib) in 4-6 hours. It is 93-98% effective, req at least 2 provider visits and is approved by the FDA

13

What is misoprostol, is it FDA approved and what are some advantages?

-Prostaglandin E1 analog causes uterine contraction and cervical softening

-FDA approved for prevention and treatment of gastric and duodenal ulcers (used off label for abortion)

-Heat stable, inexpensive, widely available

14

What are the physiologic effects of misoprostol?

stimulates uterine contractions, softens and primes cervix, prevents ulcers, causes nausea/vomiting/diarrhea, causes fevers and chills

15

What is the MOA of Mifepristone and Misoprostol together?

Mifepristone induces the abortion . 

 

16

What is the typical clinical process for mifepristone/misoprostol abortion?

Day 1:

-Counseling and informed consent, including consent for aspiration procedure if method fails

-Medical and social hx

-Lab work

-Ultrasound 

 

Day2-5:

-Mifepristone on site (200mg, but FDA req 600mg)

-Misoprostol + prescrip for pain at home

-Vaginal bleeding and cramping begins 2-5 hours post administration of misoprostol

-Bleeding can last 2-4 wks, followup after 1-2 wks req to confirm expulsion 

17

What is the MOA of Methotrexate? How long does it take, how effective is it etc?

Anti-folate: blocks division of rapidly dividing cells

-Takes 3-45 days for completion of abortion

-90-85% effective

-Req 2+ visits

-Off-lable (really a cancer drug)

-Can have bad rare side effects like alopecia, leukopenia, etc 

-Usually take in combo with mesoproxal 

18

What is the MOA of Misoprostol?

Prostaglandin analog, causes uterine contractions, used in conjunction with mifepristone or methotrexate 

19

20

How effecatious is Mifepristone/Misoprostol and up to how many days can you use it?

94-98% successful, up to 70 days gestation

21

How soon is post-abortion contraceptive care available after an abortion?

In first month post abortion. IUDs can be inserted immediately (but not after a septic abortion) after a surgical abortion and 1 week after a medical abortion

22