Elective Abortion Terms & Definitions in Medicine Study Set

what is the medical definition of abortion?

iatrogenic premature exit of the products of conception

for abortion at < 13 weeks gestational age (WGA), ____ are D&C and ___ are medication only

61% ; 39 %

for abortion at > 13 weeks gestational age (WGA), what procedures may be done?

- D&C

- D&E

- medication induction of labor

what are the top reasons why people have an abortion?

- having a baby would interfere w/ work, school or other responsibilities

- inability to afford a child

- not wanting a single parent household

- having problems w/ husband/partner

what are the options for an unplanned pregnancy?

- keep the baby

- put the baby up for adoption

- elective termination

- perinatal hospice (for mothers/parents carrying a baby w/ an anomaly that will not be viable with life)

how is elective abortion defined by KS legislation?

abortion for any reason other than to prevent the death of the mother

how is medical emergency defined by KS legislation in regards to abortion?

the condition must so complicate the medical condition of the pregnant woman as to necessitate the immediate abortion of her pregnancy

what did KS legislation change the term "fetus" to in 2011?

unborn child

as of 2011, how does KS legislation define a fetus at GA of >/= 22 wks?

pain-capable child

what are some other KS legislation changes that were made in 2011 regarding abortion?

- require parental consent (if < 18 y/o) with certain exceptions w/ court waiver

- new abortion reporting requirements

- adds a civil cause of action in certain abortion cases

- can no longer use a psychiatric diagnosis for obtaining an abortion of a pain-capable child

what must evaluation include prior to termination?

- H&P

- Hgb or Hct

- Rh type (+/-)

- determine gestational age

- screen for STIs

medical abortion can be utilized for up to __________ of gestation

70 days

medical abortion:

- can be utilized for up to 70 days of gestation

- avoids invasive procedure

- requires multiple visits

- will take days to weeks

- moderate to heavy bleeding

surgical abortion:

- any gestational age

- sedation required in most cases

- usually 1 visit

- completed much sooner

- light bleeding

what abortion techniques may be utilized in the 1st trimester?

- medical

- dilation & curettage (D&C)

what abortion techniques may be utilized in the 2nd & 3rd trimester?

- labor induction

- dilation & evacuation (D&E)

- preprocedure injection of intracardiac KCl or digoxin

- intrauterine instillation of hypertonic agents

- hysperotomy (c-section); NOT commonly used

what meds may be used to induce labor?

- misoprostol

- carboprost

- high dose oxytocin

which hypertonic agents may be instilled into the uterus to cause abortion in the 2nd or 3rd trimester?

- saline

- carboprost (prostaglandin F2 alpha)

which meds may be used for medical abortion?

- mifepristone + misoprostol

- methotrexate

what is mifepristone (RU-486)?

an antiprogestin

- necrotizes the decidua, softens the cervix, causes intrauterine contractions, increases prostaglandin sensitivity

- follow w/ misoprostol

what is misoprostol (cytotec)?

a prostaglandin

- produces uterine contractions

what must mifepristone be followed by?

misoprostol

what is methotrexate?

folic acid metabolism inhibitor

- inhibits DNA synthesis

what are the contraindications to medical terminations?

- confirmed/suspected ectopic pregnancy

- intrauterine device (IUD)

- long term systemic corticosteroid use

- chronic adrenal failure

- severe anemia

- coagulopathy/anticoagulant therapy

- allergy to the med to be given

- unable to follow up

what are the side effects of elective pregnancy termination?

- bleeding

- cramping

- HA

- dizziness

- fatigue

- thermoregulatory

- retained products of conception

- uterine rupture

how should you follow up with someone who has had an elective abortion?

- if Rh negative: RH immune globulin

- vaginal sonogram

- serial b-hCG quantitatives (to ensure that pregnancy has resolved)

- contraception

in January of 2023, the FDA approved changes to the risk evaluation & mitigation strategies (REMS) program for mifepristone. what was the change?

tablets may now be dispensed by certified pharmacies, by mail & in person

- prescribers must still be certified w/ the program

- patients still have to sign an agreement form

dilation & curettage (D&C)

a surgical procedure in which the cervix is dilated and the endometrium of the uterus is scraped away

- give preop abx

- pt will be put under anesthesia

- sharp & suction curettes will be used

what are the methods for cervical dilation in D&C?

- mechanical (rigid, tapered dilators)

- osmotic dilator (laminaria)

- prostaglandins (misoprostol)

cervical dilator

curette

these, along w/ the dilators & curettes, are used for dilation & evacuation (D&E):

sopher ovum forceps

what are some potential short-term complications of elective abortion?

- endometriosis or sepsis

- hemorrhage

- cervical laceration

- uterine perforation

- death (esp. w/ illegal abortions)

- ongoing pregnany

what are some potential long-term complications of elective abortion?

- asherman syndrome

*maybe:

- low birth weight infants

- preterm delivery

- psychosocial problems

- breast cancer

what is asherman syndrome?

intrauterine adhesions usually due to trauma

- front & back wall of uterus scar together

- usually from D&C

after an elective abortion, how long should the patient be on pelvic rest (refraining from placement of anything in the vagina, with or without cessation of sexual intercourse)?

2 wks