Abortion Counselling

Question 1

what preexisting conditions should you ask about in abortion counselling

Answer 1

coagulation disorder

cardio resp compromise

Question 2

in which patients should you confirm GA by U/S when offering abortion counselling

Answer 2

when GA is in question

if intrauterine pregnancy is uncertain

patients undergoing 2nd trimester procedures

Question 3

what STI should you screen for specifically

Answer 3

BV

sig reduction in post op PID if pre op tx with flagyl

Question 4

what should you give all Rh- women undergoing abortion

Answer 4

rhogam after termination

Question 5

first trimester abortion option

Answer 5

medical

vacuum aspiration–manual or traditional vacuum

Question 6

until how many weeks can medical abortion be offered

Answer 6

less than 8 weeks

Question 7

until how many weeks can vacuum aspiration abortion be offered

Answer 7

manual–less than 10 weeks

traditional–less than 13 weeks

Question 8

what meds are used for medical abortion

Answer 8

off label use

methotrexate + misoprostol or just misoprostol alone

Question 9

how does medical vs surgical abortion compare

Answer 9

medical is safer but less effective

Question 10

what % of medical abortions are completed (successful)

Answer 10

complete abortion rate is 90% or more in GA up to 49 days, and efficacy declines with increasing GA

Question 11

how quickly do medical abortions progress

Answer 11

78% of women pass products of conception (POC) within 24h

remainder usually have delayed medical termination which lasts over several days

Question 12

in what % of patients will you have to still do a surgical evacuation after attempting a medical abortion

Answer 12

about 1% of people will have an ongoing viable gestation that will require surgical evacuation

Question 13

contraindications to medical abortion

Answer 13

sensitivity to medications
known coagulopathy
active liver or renal disease
severe anemia
acute IBD

Question 14

second trimester abortion options

Answer 14

D&C > induction of labour > hysterectomy/hysterotomy

Question 15

what do you need to do to prepare for D&C

Answer 15

place mechanical or pharmacological dilators PV or PO 4-48 hours prior to procedure

Question 16

how quickly should pregnancy symptoms dissipate in abortion counselling

Answer 16

within one week of the pregnancy termination; normal menses should return by 6 weeks

Question 17

when should you f/u abortion

Answer 17

2-4 weeks after

Question 18

what should you educate patients to watch for with regard to complications while abortion counselling

Answer 18

recognize fever, pelvic pain, uterine elnargement, heavy bleeding, passage of tissue, and ongoing pregnancy symptoms and should seek care

Question 19

how long should you avoid vaginal intercourse and tampons for

Answer 19

2 weeks to avoid TSS

Question 20

is hcg useful to diagnose incomplete abortion

Answer 20

no–is detectable as long as 60 days post procedure

Question 21

what are the most common emotional reactions after pregnancy termination

Answer 21

relief
transient guilt
sadness
sense of loss

*address these feelings

Question 22

does the choice to terminate place women at higher risk of subsequent depression or other psychiatric diagnoses

Answer 22

no