Medication Abortion
Methods to confirm pregnancy (ACOG approved) - Name 3/4
What are: serum hcg test, home urine hcg test, ultrasound, history-based LMP GA dating
The complication rate for procedural abortion in the first trimester
What is 0.07%
The number of hours until dilapan expands adequately?
4-6 hours
The definitions of recurrent pregnancy loss
The loss of 2 or more ultrasound or histopathologic- proven losses (not including self reported losses)
Serum level of beta hcg at which a normal IUP should be seen by TVUS
2000-3000 mIU/mL
The FDA approved medication abortion regimen dosages for mifepristone and misoprostol.
What are 200 mg and 800 mcg, respectively.
Before performing a procedural abortion, obtaining and ultrasound is always recommended.
T/F?
T
Recommendations regarding safety of dilators >18 weeks EGA in the following conditions (safe/not safe):
placenta previa
low lying placenta
premature rupture of membranes
prior cesarean section
All safe
Patients pregnancy intention should guide management of EPL and PUL when patient is clinically stable.
T/F
True
Ultrasound milestones for when you should see
1. a fetal pole, and
2. cardiac activity
1. MSD >25
2. CRL > 7mm
ACOG approved gestational age (in DAYS) until which medication abortion can be offered based on LMP without ultrasound
What is 70 days (per ACOG)
[As discussed during live jeopardy, evidence based protocols are in use to support med AB up to 77days]
Name 2 clinical factors that favor cervical preparation in the first trimester and the 2 most commonly used methods of cervical preparation in the 1st trimester
Nulliparity & GA>10 weeks
Misoprostol, same day osmotic dilator
Reasons why later-term abortions are not available (2/3)
Lack of trained providers
Laws regarding abortion timing/availability
Stigma for later term abortion
The percent of clinically recognized pregnancies that end up as early pregnancy losses (EPLs)
15-20%
Gestational age at which you switch from CRL to biometry for the most accurate dating
14 weeks EGA
Diagnoses/conditions where medication abortion should not be offered- Name 3/4
What are: suspected/confirmed ectopic pregnancy, blood disorder, adrenal failure, allergy to mifepristone or misoprostol.
Antibiotics prior to and after a 1st trimester abortion procedure are recommended to prevent complications from infection.
T/F?
F, only preoperative antibiotics are recommended
(Level A)
Most common Reasons why women seek later abortion services (3/4)
1. didn't realize they were pregnant
2. difficulty making arrangements for abortion
3. afraid to disclose to family or partner
4. fetal anomaly diagnosed later in pregnancy
When the patient is clinically stable, the 3 options for management of an EPL
1. Aspiration (OR or office)
2. Medication management
3. Expectant care
The measurement of the femur length should include the distal femoral epiphysis.
T/F?
F, Each caliper should be placed at the ends of the ossified diaphysis without including the distal femoral epiphysis if it is visible
Give at least five (5) Absolute Contraindications to Methotrexate Therapy.
Porphyria, acute peptic ulcer disease, acute pulmonary disease, clinically significant liver disease, clinically significant renal disease, Ruptured Ectopic Pregnancy, Breastfeeding, Hemodynamic Instability, Sensitivity to MTX, Inability to Follow up
What is the generally accepted definition of hemorrhage for 1st tri and 2nd trimester procedures, respectively.
250 mL and 500 mL
some sources use 500mL for both
Reasons why someone might choose a medication induction over a procedural abortion (3/4)
Length of time time until expulsion of fetus
Grieving/desires to hold fetus
Wanting to experience the passage of the pregnancy
Preference for fetal body to remain intact
Antiphospholipid antibody syndrome contributes to up to this % of recurrent pregnancy loss.
What is 20.
Name 3 ways intraoperative ultrasound enhances safety during abortion procedures
Reduces risk of perforation, bleeding, incomplete evacuation and leads to shorter procedure time