HIGH-YIELD FACTS IN - Induced Abortion docx

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DEFINITION

The termination of a pregnancy medically or operatively before fetal viability;

definition of viability varies from state to state

ASSESSMENT OF THE PATIENT

Physical assessment is crucial before an elective abortion:

Ultrasound should be performed if there is a discrepancy between dates

and uterine size.

Patient’s blood type and Rh type must be evaluated; if Rh negative,

RhoGAM should be administered prophylactically.

Careful patient counseling should be performed.

TYPES OF INDUCED ABORTION

Elective voluntary: Interruption of pregnancy at the request of the mother

Therapeutic: Interruption of pregnancy for the purpose of safeguarding the

health of the mother

INDICATIONS FOR THERAPEUTIC ABORTION

Maternal Indications

Cardiovascular disease

Genetic syndrome (e.g., Marfan’s)

Hematologic disease (e.g., TTP)

Metabolic (e.g., proliferative diabetic retinopathy)

Neoplastic (e.g., cervical cancer; mother needs prompt chemotherapy)

Neurologic (e.g., Berry aneurysm; cerebrovascular malformation)

Renal disease

Intrauterine infection

Severe preeclampsia/eclampsia

HIGH-YIELD FACTS IN

Induced Abortion

Abortion may not be denied

in first 3 months of

pregnancy in any state.

Fetal Indications

Major malformation (e.g., anencephaly)

Genetic (e.g., Tay–Sachs disease)

METHODS OF ABORTION

First Trimester

MEDICAL

Antiprogesterones such as mifepristone (RU 486) or epostane; used

only before 9 weeks’ gestation. Without progesterone, the uterine lining

sloughs off.

Methotrexate IM + intrauterine misoprostol 1 week later; used only be￾fore 9 weeks’ gestation. Methotrexate is a folic acid antagonist that in￾terferes with cell division.

SURGICAL

Cervical dilation followed by aspiration curettage (D&C): Risks include cer￾vical/uterine injury and Asherman’s syndrome.

Second Trimester

MEDICAL

Intravaginal prostaglandin E2 (PGE2) or PGF2α with urea

SURGICAL

Dilation and evacuation

Complications of Surgical Abortions

Infection

Incomplete removal of products of conception (POC)

Disseminated intravascular coagulation (DIC)

Bleeding

Cervical laceration

Uterine perforation/rupture

Psychological sequelae

Death

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HIGH-YIELD FACTS Induced Abortion

What abortion method has

the lowest complication

rate? Dilation and

evacuation. Risks include:

Hemorrhage/perforation.

Medical methods of

abortions can only be used

in first 9 weeks.

LESS COMMON METHODS OF ABORTION

Medical

Intra-amnionic infusion of hyperosmolar fluid (saline + urea)

High-dose IV oxytocin (induces uterine contractions)

Surgical

Hysterotomy is used only if other methods have been unsuccessful.

A hysterotomy is a C-section of a preterm fetus.

Hysterectomy

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HIGH-YIELD FACTS Induced Abortion

Infection is the most

common complication of

hysterectomy.

Death is a risk of abortion,

but it is 10 times less

than the risk of death from

giving birth.