Repro - 1-6 Abortion

Front 1

Viability reaches over 50% at...

Back 1

24 weeks.

Front 2

Most abortions are performed...

Back 2

8 weeks or earlier.

Front 3

Rh prophylaxis

Back 3

Given after abortion to Rh negative patients so they do not develop antibodies to Rh factor.

Front 4

Aftercare instructions for infection

Back 4

Take antibiotic rx.

Insert nothing in vagina for two weeks (no sex, douche, tampons...)

Come back with fever, abd tenderness of foul discharge.

Front 5

Aftercare things that are normal

Back 5

Pain and cramping

Period after 4-8 weeks.

Preg sx gone in 1-2 days.

Milk production (will go away)

Mild depression from a drop in hormones.

Front 6

Abortion procedure is not complete until...

Back 6

ADEQUATE CONTRACEPTION IS PROVIDED

(this seems to be really important)

Front 7

Laminaria

Back 7

Stems of this seaweed can be used to dilate the cervix.

It does this by taking up water from cervix and exerts gentle pressure.

Reduces cervical lacerations but may increase infection.

Front 8

Laminaria Japonicum

Back 8

Retains integrity when wet.

Front 9

Laminaria digitate

Back 9

Becomes gelatinous as they swell and can become entrapped in the endocervical canal.

Front 10

Lamicel

Back 10

Synthetic laminaria that acts to quickly pull water from the cervix, thus making it soft. It exerts little force.

Front 11

Dilipan

Back 11

Synthetic laminaria. "Produced softening and rapid swelling."

Front 12

Intracardiac KCl or Digoxin

Back 12

Can be used in conjunction with other techniques (put in amniotic fluid I think)
Cortical softening 16-24 hours.

Front 13

Cervical shock

Back 13

Vasovagal syncope resulting from manip of endocervical canal.

Brief tonic-clonic activity can be observed. (low pulse, rapid recovery, lack of postictal state).

Can be prevented with use of atropine in local anesthetic.

Front 14

Postabortal syndrome

Back 14

Uterine atony.

Tachycardia, diaphoresis, abdominal pain.

Can be from 1/2 hour to days after the abortionl.

Tx - repeat aspiration.

Front 15

Abortion definition

Back 15

Conclusion of preg before 20 wks or weight < 500g.

Front 16

First trim

Back 16

12 weeks

Front 17

Alternative abortion def

Back 17

Conclusion before a fetus is suff developed to survive (23 weeks)

Front 18

How often is miscarriage?

Back 18

Estimated 50% of all conceptions.

Front 19

What percent of spont abortions are in first 12 weeks?

Back 19

80%

Front 20

Threatened abortion

Back 20

uterine bleeding without cervical dilation or effacement.

about 1/2 abort.

Front 21

Complete abortion

Back 21

Spont expulsion of all fetal and placental tissue

Front 22

Incomplete abortion

Back 22

Passage of some, but not all, fetal or placental tissue through the cervix.

Front 23

Inevitable abortion

Back 23

Uterine bleeding accom by cervical dilation but without expulsion of any placental or fetal tissue through the cervix
Membrane may rupture
(contrast with threatened abortion)

Front 24

Missed abortion

Back 24

Fetal death without expulsion for at least 8 weeks.

Front 25

Septic abortion

Back 25

Abortion accom by uterine infection.

Front 26

Elective termination

Back 26

for a women's desires

Front 27

therapeutic abortion

Back 27

for maintaining health of the mother.

Front 28

Counseling a mother

Back 28

mother should be allowed to choose among options without coercion, either implied or overt.

the choices are one of these 3:
continuing the pregnancy and keeping the child
continuing the preg and placing child for adoption
inducing an abortion

Front 29

Roe v. Wade

Back 29

Woman can decide whether or not to terminate her pregnancy.

Front 30

Do minors need parental consent for abortion?

Back 30

no (1976 law)

Front 31

Is risk of death higher for abortion or giving birth?

Back 31

giving birth

Front 32

First trim termination options

Back 32

Early uterine evacuation

Vacuum curettage

Medical abortion

Front 33

Early uterine evacuation

Back 33

First trim termination option - includes manual vacuum aspiration

6-10 weeks
Simplest, safest, least expensive
Examination of aspirated tissue is essential.

Front 34

Vacuum curettage

Back 34

First trim termination option
AKA suction abortion or D&C

Mechanical means with large vacuum pump.
Most common method of first trimester termination
Cervix is dilated to accom larger diameter suction curettes.

Anesthetic options are available.

Front 35

Medical abortions

Back 35

First trim option.

Includes mifepristone and methotrexate

Front 36

Mifepristone

Back 36

Progesterone receptor antagonist.
For women less than 49 LMP

standard protocol - 600mg mifepristone then on day 3 prostaglandin to induce expulsion within 4 hours of PG.

Front 37

Methotrexate

Back 37

Used before mifepristone

Good for very early preg when gestation can't be documented to be intrauterine.

Some pts may need to wait 4 weeks to resolution of pregnancy.

Front 38

Second trim termination options

Back 38

Dilatation and evac, PGF2/saline/urea, PG suppositories, high dose oxytocin, hysterotomy

Front 39

Dilatation and evacuation

Back 39

Second trim termination option
Suction removal after cervical dilation.
More difficult than earlier suction techniques.
Less complications than instillation with PGF2/saline/urea or prostaglanding vaginal suppositories

Front 40

Prostaglandin (PGF2), hypertonic saline, hypertonic urea solution

Back 40

Second trim termination option
Instillation to abortion takes 24 hours.
Fetus and placenta aborted vaginally.
PG directly causes contractions
Saline causes fetal demise, decidual necrosis, and release of PGs.

Front 41

Prostaglandin vaginal suppositories

Back 41

Second trim termination option
Placed near cervix to causes contractions and cervical dilation.
Systemic effects - vomiting, diarrhea, hyperpyrexia (v. high fever) due to PGE2

Misoprostol intravaginally is easier, cheaper and equally effective.

Front 42

High dose oxytocin

Back 42

Second trim termination option
As effective as PGE2 (suppository) but risk of water intoxication

(increases myometrium contractions)

Front 43

Hysterotomy

Back 43

Second trim termination option
Mini C-section

Other methods are preferred.

Front 44

When are abortions safer?

Back 44

The earlier you do them.

Front 45

Complications

Back 45

Hemorrhage
Infection - Use proph antibiotics
Uterine inj (lacerations of cervix or uterine perforation)
Cervical shock --> vasovagal syncope
Cardiac arrest or anaphylaxis from local anes.
Postabortal syndrome
Ectopic preg due to failed/incomplete abortion
Emotional.

Front 46

Anaphylaxis with local anes

Back 46

In asthmatics to metabisulfate preservative in epinephrine solution.