OB/LD Exam 4

Complications/Abortion

Levonorgestrel (Plan B) & Copper T IUD (Paragard)

Emergency contraceptive options used to prevent pregnancy after unprotected intercourse

Levonorgestrel (Plan B)

Taken within 72 hours of sexual activity (up to 120 hours), works by delaying ovulation and making uterine lining unfavorable for implantation

Copper T IUD (Paragard)

inserted within 72 hours of sexual activity (up to 120 hours), works by immobilizing or killing sperm and making the uterine lining unfavorable for implantation

RU486 (Mifepristone)

developed in the early 1980’s, prohibits the synthesis and functionality of progesterone resulting in: contractions of uterus, an endometrium unfavorable for implantation, softening of the cervix to allow for expulsion of the developing baby and placenta, found to only be effective approximately 80% of the time, a prostaglandin analog, was added to the regimen to stimulate contractions, approved for use until 10 gestation, sale and use in the US was not approved until 2001, by 2015, approximately 27% of all US abortions were being performed medically, but varies from state to state

Early Medical Abortion Procedure: initially requires 3 visits

consent obtained, embryonic age determined (by ultrasound) mifepristone is taken orally in the presence of the abortion provider ~ <5% will expel the embryo with this, 24-48 hours, a prostaglandin analog (Misoprostol/Cytotec) is taken at the abortion clinic, 49% abort within 4 hours of misoprostol administration and 75% abort within 24 hours, two weeks later, an ultrasound is done - if the mother is still pregnant, a vaccum aspiration abortion (D/C) surgical abortion is scheduled, more recently, one or both medications despensed through pharmacy and can be taken at home (some states require ultrasound for gestational dating and some do not)

Surgical Abortion

Suction curettage abortion (D&C w/ vacuum aspiration), Dilation and evacuation (D&E), dilation and extraction or partial birth abortion (D&X)

Suction Curettage Abortion : D&C w/ vacuum aspiration

most common abortion procedure in the world “virtually all modern first-trimester surgical abortions are accomplished by vacuum aspiration” rarely performed after 12 wks gest

D&C w/ vacuum aspiration procedure

Anesthesia, cervix manually dilated, speculum inserted to visualize cervix, cannula inserted, cannula attach to suction, developing baby and placenta aspirated by suction, 50% the curette to scrape uterus from remaining contents

D&E

approx 8% of abortions occur after 13 wks gest, 96% of all second trimester abortions are performed by D&E, globally 2/3 of all major complications and ½ of all abortions related maternal deaths caused by abortion are from those that take place after the first trimester

D&E procedure

cervix manually dilated - may take 1-2 days, some degree of sedation or anesthesia may be used, speculum inserted to visualize cervix, forceps inserted through dilated cervix to grasp baby, baby and placenta forcibly removed by forceps, which dismembers to estimate gest age, postop observation lasts for an hour or more for bleeding, pain that may signal uterine atony, DIC, or uterine perforation

Dilation & Extraction (D&X) or partial birth abortion

variant of D&E where the baby is delivered intact instead of in pieces, in the US this method was federally banned in 2003 - partial birth abortion ban act - upheld by the Supreme Court in 2007 in Gonzales v. Carhart

D&X procedure

Partial birth/delivery of baby head, incision at base of skull through which intracranial contents are suctioned. Surgeon peirce calvarium with sharp instrument and collapse it externally