What % of women have had an induced abortion?
What is the safest and most common time to have an abortion?
<8 weeks=lowest risk of death. Most common is first trimester
What is safer? Abortion or pregnancy?
ABORTION! at all stages of preg
What is the strongest risk factor for abortion related mortality?
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.
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.
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
What is recognizable tissue at 5-7wks
Decidua (lines uterus during preg) and trophoblastic villi
What is recognizable tissue at 8-9wks
Decidua, placenta (formally trophoblastic tissue), embryo/fetus
What is recognizable tissue at 9-12wks
Decidua, placenta (opaque, dense, pink), fetal parts
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
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
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
What are the physiologic effects of misoprostol?
stimulates uterine contractions, softens and primes cervix, prevents ulcers, causes nausea/vomiting/diarrhea, causes fevers and chills
What is the MOA of Mifepristone and Misoprostol together?
Mifepristone induces the abortion .
What is the typical clinical process for mifepristone/misoprostol abortion?
-Counseling and informed consent, including consent for aspiration procedure if method fails
-Medical and social hx
-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
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
-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
What is the MOA of Misoprostol?
Prostaglandin analog, causes uterine contractions, used in conjunction with mifepristone or methotrexate
How effecatious is Mifepristone/Misoprostol and up to how many days can you use it?
94-98% successful, up to 70 days gestation
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