1st Tri Abortions
Limb defects with or without Mobius syndrome
What is the most effective/inexpensive regimen for surgical antibiotic prophylaxis for surgical termination?
Bonus: by what percent does ppx abx decrease the risk of infection?
100mg doxycycline taken orally 1 hour before the abortion followed by 200mg after the procedure
40%
In what order, does ACOG recommend discussing contraception options?
Most effective methods first.
After how long should we consider another option for Depot due to concerns for irreversible bone mineral density loss?
Frozen Precipitation Commence
Let it Snow
Name two medical conditions were a medication abortion may be preferable to a uterine aspiration.
1. uterine fibroids that distort the cavity
2. congenital uterine anomalies
3. introital scarring
What is the most common complication of a medical abortion in the 2nd trimester?
Retained placenta (21%)
On ultrasound, a patient with an IUD without visualized strings is found to have an IUD in the lower uterine segment above the internal os, what is the next step in management?
Assess for symptoms. Expectant management vs removal w/ shared decision making.
What is the dose of mifepristone for medication abortions?
200mg 24-48 hours prior to misoprostol.
Testimony of witness of maternal parent's infidelity with Kris Kringle
I saw Mommy Kissing Santa Clause
Name 5 contraindications for a medication abortion.
Ectopic, IUD in place, long-term steroid use, chronic adrenal failure, coagulopathy, anti-coagulant therapy, porphyria, intolerance/allergy to mife/miso.
Name 2 risk factors that correlate with risk of uterine perforation during surgical abortions.
Advanced gestational age, multiparty, provider inexperience, inadequate cervical preparation.
What contraception if started on day 1 of a medication abortion, may increase the risk of ongoing pregnancy?
DMPA
What percent of women who use IUDs have Actinomyces-like organisms on cytology and are asymptomatic?
7%. No antimicrobial treatment needed and the IUD can be left in place
Sir Lancelot with Laryngitis
Silent Night
What are the mechanisms of action of mifepristone and misoprostol?
Mifepristone - selective progesterone receptor modulatory that binds with greater affinity that progesterone but does not activate
Misoprostol - prostaglandin E1 analogue
What drug can be injected into the cervix to decrease the amount of blood loss from a D&E?
Vasopressin
What are the next three steps after seeing a patient n the office with a non-palpable arm implant?
Exclude pregnancy, offer emergency oral contraceptives, imaging to locate the device
How many women out of 10, will have an abortion by age 45?
3
Do you perceive the same longitudinal pressure which stimulates my auditory sense organs
Do you hear what I hear?
What criteria must be met to perform a medication abortion without US confirmation? (3)
Regular menstrual cycles, LMP w/i 56 days, no signs or symptoms of an ectopic pregnancy.
How many times higher is the risk of death associated with childbirth compared to the risk of death with abortion.
14
List the 5 Ps for taking a comprehensive sexual history.
Partners, practices, protection from STDs, past history of StIs, and prevention of pregnancy
After a medication abortion, what endometrial thickness is considered confirmatory of successful termination on follow-up ultrasound imaging?
Sole purpose of follow up US is to determine presence of gestational sac. Endometrial thickness does not predict need for subsequent aspiration.
Boulder of the tinkling metal spheres
Jingle Bell Rock