The termination of a pregnancy medically or operatively before fetal viability; definition of viability varies from state to state A S S E S S M E N T O F T H E PAT I E N T Abortion may not be denied in first 3 months of pregnancy in any state. Physical assessment is crucial before an elective abortion: Ultrasound should be performed if there is a discrepancy between dates and uterine size. Patient’s blood type and Rh type must be evaluated; if Rh negative, RhoGAM should be administered prophylactically. Careful patient counseling should be performed. . | high Induced Abortion DEFINITION The termination of a pregnancy medically or operatively before fetal viability definition of viability varies from state to state I ASSESSMENT OF THE PATIENT Abortion may not be denied in first 3 months of pregnancy in any state. Physical assessment is crucial before an elective abortion Ultrasound should be performed if there is a discrepancy between dates and uterine size. Patient s blood type and Rh type must be evaluated if Rh negative RhoGAM should be administered prophylactically. Careful patient counseling should be performed. I TYPES OF INDUCED ABORTION Elective voluntary Interruption of pregnancy at the request of the mother Therapeutic Interruption of pregnancy for the purpose of safeguarding the health of the mother INDICATIONS FOR THERAPEUTIC ABORTION Maternal Indications Cardiovascular disease Genetic syndrome . Marfan s Hematologic disease . TTP Metabolic . proliferative diabetic retinopathy Neoplastic . cervical cancer mother needs prompt chemotherapy Neurologic . Berry aneurysm cerebrovascular malformation Renal disease Intrauterine infection Severe preeclampsia eclampsia 137 Fetal Indications Major malformation . anencephaly Genetic . Tay-Sachs disease METHODS OF ABORTION HIGH-YIELD FACTS First Trimester Medical Antiprogesterones such as mifepristone RU 486 or epostane used only before 9 weeks gestation. Without progesterone the uterine lining sloughs off. Methotrexate IM intrauterine misoprostol 1 week later used only before 9 weeks gestation. Methotrexate is a folic acid antagonist that interferes with cell division. SURGICAL Cervical dilation followed by aspiration curettage D C Risks include cer-vical uterine injury and Asherman s syndrome. Medical methods of abortions can only be used in first 9 weeks. What abortion method has the lowest complication rate Dilation and evacuation. Risks include Hemorrhage perforation. Second Trimester Medical Intravaginal prostaglandin E2 PGE2 or PGF2a with
