Elective termination of pregnancy

Question 1

First trimester abortion options?

Answer 1

• Suction curettage (7-13 weeks) SAFEST
• Manual vacuum aspiration (up to 10 wks)
• Medical options: methotrexate or mifepristone (only used up to 63 days aka. week 9 after LMP)

Question 2

Second trimester abortion options?

Answer 2

• Surgical evacuation (D&E)
• Medical induction of labor
• High-dose oxytocin
• Intra-amniotic installation agents
• Prostaglandins

Question 3

When is the last time elective abortions can be performed? From then on it’s only if there’s imminent harm to mother’s life…

Answer 3

24 wks (viability)

Question 4

What 3 things need to be done before proceeding with procedure?

Answer 4

1) Confirm gestational age
2) Give RhoGAM to all Rh- women
3) STI screening for infections

Question 5

What medicines for the procedure?

Answer 5

• Paracervical block w/ IV conscious sedation STET

- Antibiotic prophylaxis (doxycycline, ofloxacin, ceftriaxone, metronidazole)

Question 6

What is mifepristone?

Answer 6

Synthetic progesterone receptor antagonist

Question 7

How do you administer mifepristone?

Answer 7

1) Single oral dose of mifepristone (RU 486).
2) Buccal or vaginal dose of MISOPROSTOL (Cytotec) 24-48 hours later
3) Get a b-HCG read 2 weeks later to make sure it worked, or do U/S

Question 8

What is methotrexate?

Answer 8

A dihydrofolate reductase inhibitor drug that interferes with DNA synthesis which prevents placental villi proliferation.
OFF-LABEL ABORTIFACENT. Used for ectopic pregnancy.
Used with prostaglandin analog too.

Question 9

Who should not take methotrexate?

Answer 9

Immunodeficiency
Hepatic disease
Renal disease

Question 10

How is methotrexate administered?

Answer 10

Within 49 days of LMP
Give Cytotec 6-7 days later

THE ADDED CYTOTEC MAKES IT MORE SUCCESSFUL

Question 11

What are the most common side effects of the medical options for abortion?

Answer 11

Abdominal pain and cramps
Uterine bleeding

…the symptoms of miscarriage

Question 12

Bleeding during medical abortion timeline?

Answer 12

Start 2 hours after taking the prostaglandin analog.
Completed in 24-48 hours usually.
Bleeding lasts from 10-17 days.

Question 13

Main reason for 2nd trimester (after 14 wks) abortions?

Answer 13

Congenital fetal abnormalities

Question 14

Describe D&E

Answer 14

1) Osmotic dilator into cervix the day before the procedure bc a wider dilation is needed
2) Large suction cannula then extracts (forceps can be used greater than 16 wks)
3) IV conscious sedation guided by u/s

Question 15

How does induction of labor work?

Answer 15

Cervical ripening agents
High dose IV oxytocin infusion to stim contractions

Feticidal agents (intraamniotic saline or digoxin and intracardiac potassium chloride) can be used in conjunction with prostaglandins to avoid the possibility of live birth

Question 16

Complications of induction of labor abortion?

Answer 16

Retained placenta
Incomplete abortion
Hemorrhage
Infection
Cervical laceration

Question 17

Side effects of induction of labor abortion?

Answer 17

Nausea/vom/diarrhea/fever/chills

Question 18

D&E versus induction?

Answer 18

D&E is safer, shorter, and outpatient