medical and surgical abortion

Question 1

Antibiotics

Answer 1

Induced abortion/dilation and evacuation:
– Doxycycline 100 mg orally 1 hour before
procedure and 200 mg orally after procedure
– Metronidazole 500 mg orally twice daily for 5 days

Question 2

When is cervical prep recommended

Answer 2

by 12-14 weeks
Misoprostol
• 400 mcg vaginally/buccally 3‐4 h, orally 8‐12 h, or
sublingually 2‐4 h before the procedure

Question 3

Diagnosis of Bleeding

Answer 3

Cervical laceration
• Retained tissue
• Uterine atony
• Placental abnormality
• Perforation
• Coagulopathy

Question 4

Hematometra

Answer 4

Intense cramping
• Minimal bleeding
• Diaphoresis
• Vasovagal reaction
• Uterine enlargement on
exam
• On u/s, re‐accumulation of
blood is seen

Treatment
– Immediate re‐suctioning
– Uterotonics

Question 5

High risk uterine perforation

Answer 5

– Lateral defect
– Suction was on at the time of perforation
– Larger defect (>1.2 cm)
– Acute pain or symptomatic blood loss
– Sighting of bowel elements

Question 6

What do you do if perforation and excessive bleeding?

Answer 6

Can consider completing the procedure under ultrasound guidance

Question 7

Mifepristone

Answer 7

– Anti‐progestin
– Necrotizes the decidua, softens the cervix, increases
uterine contractility and prostaglandin sensitivity

up to 10 weeks gestation

Question 8

misoprostal

teratogen

max dose

Answer 8

Possible limb and facial abnormalities

Max dose: 1400 mcg in 24 hours

Question 9

Contraindication of medical abortion

Answer 9

• Anemia, Hgb <9.5 g/dL
• Confirmed or suspected ectopic pregnancy
• IUD in place
• Current long‐term systemic corticosteroid therapy
• Chronic adrenal failure
• Known coagulopathy or anticoagulant therapy
• Intolerance or allergy to mifepristone
• Severe liver, renal, respiratory disease, uncontrolled
hypertension or cardiovascular disease

Question 10

Medical Regimen

Answer 10

On Day 1: 200 mg of mifepristone taken by
mouth
• 24‐48 hours after taking mifepristone: 800 mcg
of misoprostol taken buccally, at a location
appropriate for the patient
• About 7 to 14 days after taking the mifepristone,
follow up with a healthcare provider

• Failure rate: 2% to 7%
  • Continuing pregnancy rate: 1% to 3%

Question 11

Clostridial toxic shock

Answer 11

Hemoconcentration and significant leukocytosis without

fever, rapid progression to refractory hypotension and death

Question 12

Incomplete abortion Medical Termination

Answer 12

Misoprostol 600 mcg orally

or 400 mcg sublingually

Question 13

Missed Abortion Medical termination

Answer 13

800 mcg vaginally or 600
mcg sublingually, repeat in
3‐24 hours for two
additional doses

Question 14

Labor Induction Abortion

Answer 14

miso 800 mcg loading than 400 mcg vaginally q 3 hours

Question 15

Labor induction with prior c-section

Answer 15

miso 400 mcg vaginally q 6 hrs

Question 16

COP IOL

Answer 16

20-100 units of oxytocin over 3 hours
off 1 hour
increase to 300 units over 3 hours

Question 17

How long to wait for the placenta

Answer 17

around 4 hours but may depend on bleeding

can give 10 im of pitocin

Question 18

No expulsion after 24 hours of miso

Answer 18

Stop and do an ultrasound

- If not effective in 2-3 days may need surgery.

Question 19

Who is recommended to have a D&E

Answer 19

previa after 24 weeks

prior c-section and previa