Description #
This is an Obstetrics and Gynecology unit.
Learning Objectives #
The Students should be able to:
– List surgical and non-surgical pregnancy termination methods
– List potential complication:
– Discuss psychosocial considerations and ethical issues
Objectives #
Prepared by: Garson Romalis, MD, FRCSC
As a future medical practitioner, you are expected to:
1. Have a general understanding of the current abortion controversy.
2. Know the steps in helping a patient decide how to deal with an unintended pregnancy.
3. Understand that contraception is preferable to abortion, but that both contraception and people fail.
4. Be familiar with emergency contraception (“Morning after pill”)
5. Be familiar with the techniques and complications of first trimester abortion:
a. Medical
– Mifepristone (RU 486)
– Methotrexate
b. Surgical
-Anesthesia: General or Local
-Laminaria
6. Be familiar with the techniques and complications of second trimester abortion:
a. Surgical
b. Induction
Abortion techniques #
Prepared by: Garson Romalis, MD, FRCSC
1. Less than 7 weeks:
a. Medical
-Methotrexate 50 mg/m2 IM followed 7 days later with Misoprostol 800 mcg vaginally.
~90-95% effective <49 days
– Mifepristone (RU 486) not yet available in Canada – 600 mg PO followed 2 days later with Misoprostol 400 mcg orally/vaginally.
~97% effective <49 days
b. Surgical – Manual Vacuum Aspiration (MVA)
2. 6 – 13 weeks:
Hospital or free standing clinic
Anesthesia
General
Local
Laminaria vs. operative dilatation (Misoprostol is coming into more use for cervical preparation)
3. 13 – 20 weeks:
Surgical (Dilatation & Evacuation)
Hospital or free standing clinic
Laminaria dilatation mandatory (Misoprostol is coming into more use for cervical preparation)
Anesthesia: General or Local
Induction methods:
Intra-amniotic Prostin (historical)
Intra-amniotic Hypertonic Saline (historical)
Intra-amniotic Urea (Not used in BC)
Vaginal (or oral) Misoprostol )with or without osmotic dilators, with or
Oxytocin infusion )without fetal euthanasia.
4. Termination for abnormal pregnancy:
a. Surgical
b. Induction
RISKS AND COMPLICATIONS:
– Increased with gestational age.
Mortality <1/ 100,000
<12 weeks – 0.5
>13 weeks – 3.7
Induction – 7.1
Hysterotomy- 51.6
Overall – 1.0
Continuing with pregnancy – ~7 – 10/100,000
– Decreased with – prophylactic antibiotics
– laminaria
– local anesthesia
– liberal ultrasound
– experienced operators