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Surgical Abortion

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Medical Abortion ( 56 days LMP) 14-24 Weeks ... Bleeding May Occur for 2 Days 2 Weeks. Appropriate Contraception May Commence Immediately or Soon Thereafter ... – PowerPoint PPT presentation

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Title: Surgical Abortion


1
Surgical Abortion
  • David Blair Toub, M.D.
  • Dept. of Obstetrics and Gynecology
  • Pennsylvania Hospital

2
Introduction
  • 1973 Roe v. Wade Trimester Approach
  • Number of Abortions Stable or Decreasing
  • 1/3 of Women 15-44 Undergo Abortion
  • Abortion 10-11x Safer than Continuing Pregnancy,
    2x Safer than PCN Injection
  • 91 1st TM, 9 2nd TM, .01 3rd TM
  • 1965 Illegal Ab 17 of Maternal Deaths

3
Patient Evaluation
  • Counseling, ACA (in PA)
  • Pregnancy Test
  • History LMP, Medical Risk Factors
  • PEx Confirmation of Gestational Age
  • TRh, Hct
  • U/S if Significant Discrepancy on Exam or
    Recent Vaginal Bleeding

4
Techniques
  • 14 Weeks
  • Suction Curettage
  • Medical Abortion ( 56 days LMP)
  • 14-24 Weeks and Beyond
  • Dilatation and Evacuation (DE)
  • Intact DE (DX)
  • Labor Induction Methods (Prostaglandins)
  • Amnioinfusion (HS, Urea, Prostaglandins)

5
Cervical Dilatation
  • Mechanical
  • Done at Time of DE
  • Convenient for Patient
  • May be Uncomfortable
  • Increased Risk of Perforation (Compared
    with Osmotic Dilators)

6
Cervical Dilatation
  • Osmotic Dilators (e.g. Laminaria)
  • Increased Time, Inconvenience
  • Less Pain, Decreases Perforation Risk
  • Examples
  • Laminaria japonicum, L. digitatum
  • Dilapan
  • Lamicel

Synthetic
7
Suction Curettage
  • Office, Clinic or Hospital Setting
  • Local (Paracervical Block) or IV Sedation
  • General Anaesthesia Increases Risk
  • Prophylactic Doxycycline Decreases Endometriitis
    Risk
  • Rigid or Osmotic Dilators Used
  • No-Touch Technique

8
Dilatation and Evacuation
  • Avoid Mechanical Dilatation if Feasible
  • Requires Additional Experience and Training
  • Safer than Amnioinfusion in Most Cases when
    Performed by Experienced Operator
  • Less Emotionally Traumatic for Most Patients
    (Compared With Labor Induction)

9
Additional 2nd / 3rd Trimester Methods
  • Labor Induction
  • PGE Vaginal Suppositories
  • Amnioinfusion (Hypertonic Saline, Urea,
    Prostaglandins)
  • Oxytocin
  • DX
  • Hysterotomy (Outmoded Should be Abandoned)

10
Complications
  • Bleeding
  • Infection
  • Retained POC
  • Missed Abortion
  • Perforation low risk, high risk variants
  • Hematometra (postabortal, or re-do syndrome)
  • Undiagnosed Ectopic Pregnancy

11
Postabortion Management
  • Bleeding May Occur for 2 Days 2 Weeks
  • Appropriate Contraception May Commence
    Immediately or Soon Thereafter
  • Significant Pain, Bleeding or Fevers Should
    Prompt Evaluation
  • Patients Should Follow-up in 2-4 Weeks (UCG May
    Still Be Positive)
  • If Tissue Sent for Histology Check Report

12
Summary
  • Surgical Abortion Is a Safe Procedure
  • Complications,While Infrequent, May Be Serious
  • Since Roe, There Has Been a Dramatic Reduction in
    Maternal Mortality From Illegal Abortion
    Procedures
  • The Need for Abortion May Be Reduced by
    Appropriate Contraception
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