Ectopic pregnancy, abortion, GTD || with Accurate Answers 100%.
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Ectopic Pregnancy, Abortion, GTD || With Accurate
What are the pre procedure steps for pregnancy termination? correct answers - determine correct gestational age for procedure selection and legality
- CBC hematocrit and hemoglobin, Rh blood type (termination is a blood mixing event)
- U/S for determining gestational age and fetal viability
...
Ectopic pregnancy, abortion, GTD || with Accurate Answers
100%.
What are the pre procedure steps for pregnancy termination? correct answers - determine correct
gestational age for procedure selection and legality
- CBC hematocrit and hemoglobin, Rh blood type (termination is a blood mixing event)
- U/S for determining gestational age and fetal viability
- abx prophylaxis of doxycycline for all surgical procedures
Medication abortion can be used in what scenerio? correct answers Intrauterine pregnancy up to
70 days gestation
what are the advantages and disadvantages of medication abortion? correct answers advantage:
avoidance of surgical procedure and anesthesia
disadvantage: more discomfort and awareness of procedure
Describe the process of medication abortion correct answers Step 1:
- Administer 200mg mifepristone PO in medical clinic
- if vomiting occurs, repeat dose
Step 2:
- 24-48 hrs after mifepristone, pt self administers 4x 200 mcg tablets misoprostol PO held in
place for 30min
- prophylax w/ NSAID and antiemetic for abd pain and GI ADRs
Step 3:
- pt will likely abort w/in several days
Mifepristone and misoprostol mechanisms? correct answers Mifepristone
- antiprogesterone
- can be reversed w/ progesterone
Misoprostol
- prostaglandin analogue
- (prostaglandins cause abd pain in periods, so ADR of misoprostol is abd pain)
After pt has been administered mifepristone they decide they do not want to proceed w/ abortion.
What is the next step? correct answers Tell pt not to take the misoprostol => administer
progesterone to reverse the mifepristone
If pt takes misoprostol it is irreversible
, When can uterine aspirations be performed? correct answers commonly performed up to 14wks
gestation
Describe the process of uterine aspiration correct answers - Anesthesia (paracervical block +/-
sedation)
- mechanical cervical dilation
- aspiration +/- intraoperative ultrasound
- tissue eval to confirm complete abortion
Describe the process of dilation and evacuation correct answers - softening and dilation of cervix
w/ osmotic, pharmacologic, and/or mechanical dilators
- +/- injection to induce fetal demise, either potassium chloride into fetal heart or umbilical vein,
or digoxin into amniotic fluid, fetal heart, body, or umbilical vein
- evacuation of uterus w/ suction, extraction forceps, and curettage. Fetus is delivered in breech
position until skull is lodged above internal os. Skull is decompressed, then remainder is
delivered intact
advantages and disadvantages of dilation + evacuation versus T2 medication induction? correct
answers Advantage: predictable timing, decreased cost, shorter duration of procedure
disadvantage: associated w/ increased maternal morbidity/mortality, more social/emotional
challenges, pt does not get to see POC after the surgery
describe the process of T2 medication induction abortion correct answers - Cervical preparation
w/ prostaglandin analog (misopristol)
- +/- induced fetal demise w/ digoxin or potassium chloride to prevent live birth and may shorten
induction to abortion interval
- induction w/ mifepristone 24hrs before => misoprostol
- expulsion will occur in about 12-16 hrs
Outside of normal tx, what must be done w/ every abortion? correct answers alloimmunization
prevention - rhogam in any Rh- mom
What are the risks of T2 medication induction abortion? correct answers same risks as a normal
delivery
- uterine atony, placental hemorrhage, etc
Advantages, disadvantages of T2 medication induction vs dilation + evacuation? correct answers
Advantages: pt gets to see POC
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