Reproductive choices Flashcards Preview

REPRO > Reproductive choices > Flashcards

Flashcards in Reproductive choices Deck (14):
1

Unplanned pregnancy epidemiology

80mil/y
45 m terminated compared to 135 m births
47k women die because of unsafe abortion

2

Unsafe abortion

restrictive abortion laws
untrained providers
unsafe abortion
high abortion mortality
death dramatically decreased after legalization

3

Moderately effective contraception

6-12/100/y
injectable
pills
patch
ring
diaphragm

4

Less effective contraception

18 or more/100/y
male, female condoms
sponge
withdrawal
spermicides
fertility-awareness

5

Lifetime risk of abortion

Canada: 31% of women have an abortion by age 45

6

Early surgical method of abortion

suction/aspiration (prev. dilation + curettage)
local anesthetics
fastest way to rule out ectopic pregnancy
controlled, single visit

7

>14 w surgical method of abortion

dilation and evacuation
~5% of all abortions
1/2 are fetal indications
cervical prep essential - osmotic dilators, misoprostol
BC: 2 days if 14-20 wks, 3d if >20
induction of fetal demise over 18 wks
controlled +/- GA
quick, no labour

8

> 14 w medication abortion

>16 w but usually >18 w
fetal demise induced prior to induction - KCl, digoxin
Misoprostol
Intact
No surgery

9

Abortion complication rates

Complication rate 0.68%
retained products of conception 0.38%
hemorrhage 0.08
infection 0.03

10

Early medication abortion

mifepristone (not yet available in Canada) and methotrexate
- fetal demise
- methotrexate: teratogenic; up to 7 wk LMP only
Misoprostol
- PG antagonist
- cause expulsion of pregnancy
- can be used alone (very early) to cause termination by itself: but only ~60% effective
Private
no surgery

11

Safety of abortion

Illegal - 1/280 mortality
Legal - 1/150 000 mortality
further fertility after an induced abortion - similar to that after a miscarriage at same gestation
No association between abortion and breast ca
1st trimester abortion poses no risk of: infertility, ectopic pregnancy, miscarriage, birth defect, preterm/lowBW at delivery

12

Abortion complication rates

Complication rate 0.68%
retained products of conception 0.38%
hemorrhage 0.08
infection 0.03

13

CMA policy on abortion

No discrimination against doctors who choose not to perform/assist abortions
Respect for right of personal decisions stressed
No discrimination against doctors who provide abortion services
Early diagnosis of pregnancy/determination of appropriate management encouraged
Patient provided with option of full and immediate counselling services in the event of unwanted pregnancy
No delay in provision of abortion services

14

Ethical issues in refusal to treat - CPS BC

Responsibilities to the patient:
- inform patient when personal values would influence recommendations
- do not discriminate