Clinical: Therapeutic Abortion Flashcards Preview

Block I: Reproduction & Sexuality > Clinical: Therapeutic Abortion > Flashcards

Flashcards in Clinical: Therapeutic Abortion Deck (23):
1

Define abortion

The willful termination of pregnancy before 20 weeks (because after this point the fetus may survive)

2

What is an "abortion" over 20 weeks gestation called?

Immature termination of pregnancy (NOTE: only done if risk of health of mother or fetus)

3

Date that abortion was criminalized in Canada

1869

4

Date that abortion law was amended in Canada

1969

5

Describe the amended abortion law in Canada

  • Abortion allowed if continuation was deemed a threat to a patient's physical or emotional health
  • Had to be done by a licensed MD in a certified healthcare facility after approval by an abortion committee comprising at least 3 MDs on staff

6

Compare the pregnancy associated mortality with that of induced abortion

  • Pregnancy = 8.8 deaths/ 100,000 live births
  • Induced abortion = 0.6 deaths/100,000 live births

7

6 aspects of abortion work up

  • Confrim pregnancy with HCG/Ultrasound
  • Determine blood type
  • Check rubella status if primigravida
  • Check hemoglobin
  • STD screen or prophylactic antibiotics
  • Imaging discrepant size/dates
    • Viability
    • Ectopic
    • Uterine anomaly

8

9 steps to abortion technique

  1. Speculum
  2. Antisepsis
  3. Anesthesia
  4. DIlatation
  5. Aspiration
  6. 50 mm Hg negative pressure
  7. Laminaria
  8. Blier forceps
  9. Prophylactic antibiotics

9

2 aspiration devices

  • Karman cannula
  • Sorenson curette

10

8 complications of surgical abortion

  • Incomplete abortion
  • Hemorrhage
  • Infection
  • Continuing pregnancy
  • Perforation
  • Local anesthetic reaction
  • Vagal syndrome
  • Post abortal syndrome

11

How to differentiate between a local anesthetic reaction and a vagal syndrome

Both involve convulsions, but local anesthetic reaction has a rapidly bounding pulse, whereas you cannot find pulse in vagal syndrome

12

Define post abortal syndrome

Blood clot; cannot come through cervical opening

13

When can early medical termination be used?

Up to 63 days after LMP

14

3 early medical abortion agents

  • Mifepristone (RU-486)
  • Misoprostol
  • Methotrexate

15

4 tests that must be performed with abortion

  • Pregnancy test
  • Ultrasound
  • Hemoglobin or hematocrit
  • Blood type (give anti-d immune globulin if required

16

2 advantages of medical abortion

  • Usually avoids invasive procedure
  • Usually avoids anaesthesia

17

4 disadvantages of medical abortion

  • 2 or more visits
  • Moderate to heavy bleeding
  • Requires follow-up
  • Need compliant reliable patient

18

2 disadvantages of surgical abortion

  • Invasive procedure
  • Sedation can be used

19

4 advantages of surgical abortion

  • Usually one visit
  • Bleeding light
  • Follow up not as necessary (compared to medical)
  • One step process

20

7 contraindications for abortion

  • Ectopic pregnancy
  • IUD in place
  • Undiagnosed adnexal mass
  • Corticosteroid therapy
  • Anemia
  • Coagulopathy or anticoagulation
  • Most serious systemic diseases

21

When is late medical termination use?

Genetic terminations to allow autopsy of the fetus to guide management of future pregnancies

22

4 parts to late medical termination

  1. Laminaria
  2. Misoprostol (Cytotec)
  3. Pain management
  4. Retained placenta

23

5 abortion methods no longer used

  • Hypertonic saline 20%
  • Hypertonic urea 40%
  • Hypertonic glucose 50%
  • Hysterotomy
  • Hysterectomy