Questions and Answers
When can an IUD be inserted after a medication abortion?
What is the primary purpose of assessing quantitative Beta hCG levels after abortion?
What is a contraindication for medication abortion?
What is a potential advantage of aspiration abortion compared to medication abortion?
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When should a phone or in-office visit be scheduled to assess completion of abortion?
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What is a common indication for ultrasound evaluation during pregnancy?
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What is a potential disadvantage of aspiration abortion?
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When can depo, pills, patch, and ring be initiated after medication abortion?
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What is the primary concern when assessing the severity of symptoms in a patient's history?
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What is included in a patient's menstrual history?
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What is the primary goal of asking about sexual health in a patient's history?
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What is the purpose of cervical cancer screening?
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What is included in a patient's gynecologic procedures and surgeries history?
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What is the purpose of the PA question in the PATH questions?
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What is an essential aspect of the general physical exam in a gynecologic visit?
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What is the primary concern when evaluating the course of a patient's pregnancy?
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What is an essential aspect of genital and breast hygiene assessment?
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What is the purpose of assessing urologic and rectal health in a gynecologic visit?
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What is the age threshold for ordering hrHPV testing with an ASCUS pap result?
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What type of Pap test is required for Co-testing?
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How many FDA-approved primary HPV tests are there?
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What is the recommended screening interval for primary HPV testing according to ACS guidelines?
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For HIV-infected and immunocompromised individuals, when should cytology alone be started?
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What is the purpose of using acetic acid during colposcopy?
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What is the recommended action for abnormal areas during colposcopy?
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Study Notes
Abortion Care
- Labs to perform:
- H and H (if > 10 weeks or history of anemia)
- Rh status
- Quantitative Beta hCG
- Determine if ultrasound is required:
- Concern for ectopic pregnancy
- Uncertain LMP
- Irregular menses
- Vaginal bleeding
- Size/date discrepancy
- Initiating contraception:
- Implant can be inserted at the time of mifepristone
- Pills, patch, and ring can be started the day after mifepristone
- IUD can be inserted at the follow-up visit after confirming completion
Assessing Completion of Abortion
- In-office or phone visit within 1-2 weeks
- Hx of abortion completion:
- Appropriate bleeding after misoprostol
- No further pregnancy symptoms
- Declining quantitative Beta hCG:
- 80% decline in Beta hCG after 1 week
- Ultrasound:
- Verify prior gestation sac is no longer present
- Negative home UPT:
- 4 weeks after mifepristone
- If positive UPT, need evaluation for ongoing pregnancy and possible aspiration abortion
Aspiration Abortion
- Takes minutes, no follow-up needed
- Can be performed up to 14 weeks safely
- Multiple anesthesia options
- Shorter bleeding period
- Disadvantages:
- Requires pelvic instrumentation
- Less patient control
- Potential medication adverse effects
- Analgesia and anxiolytic options:
- NSAIDs
- Local anesthesia
- Moderate or deep sedation
- Additional comfort measures:
- Heat packs
- Music
- Patient-centered language vs. triggering language
- Procedure lasts about 5-10 minutes
- IUD can be inserted immediately after the procedure
Cervical Cancer Screening Guidelines
- High-risk HPV necessary but not sufficient for the development of squamous cervical neoplasia
- HPV infection:
- Transient or persistent
- HPV 16 and 18 responsible for most types of HPV
- Factors in persistence:
- Genotype of HPV
- Cigarette smoking
- Compromised immune system
- HIV
- Age > 30 years at the time of infection
- Risk factors for cervical CA:
- Age: coitarche < 25 years old
- Gynecologic health history
- Menstrual history
- Sexual health
- Contraceptive use
- Pregnancy history
- History of vaginal and sexually transmitted infections
- Genital and breast hygiene
- Gynecologic procedures and surgeries
- Urologic and rectal health
- Cervical cancer screening
Physical Exam for Gynecologic Visit
- General physical exam:
- Height
- Weight
- Blood pressure
- Pulse
- Temperature
- BMI
- General appearance:
- Posture
- Emotional state
- Appropriateness of dress
- Speech pattern
- Social interaction
- Eyes, ears, nose, throat
- Neck
- Thyroid
- Chest and lungs
- Spine
- Kidneys (checking for CVA tenderness)
- Reflexes
- Peripheral circulation and varicosities (inspect the legs and feet)
- Abdomen exam
- Breasts and axillary lymph nodes
- Breast exam starts with the patient in a sitting position
Reproductive Goals/Intentions: PATH Questions
- PA: do you think you might like to have (more) children at some point?
Cervical CA Screening Guidelines
- Reflex HPV will test for hrHPV if the cytology is ASCUS (but only order this hrHPV in women > 25 years old)
- Conventional (slide-based) cannot order HPV testing
- Co-test Pap: only liquid-based; does cytology and HPV high-risk are both performed
- Reflex to 16, 18/45 will test for genotypes if hrHPV is positive
- Primary hrHPV test:
- Only 2 FDA-approved primary tests
- Same collection procedure as liquid Pap
- Tests for genotypes 16 and 18 and twelve other hrHPV types
- If positive, reflex to cytology is preferred
- If 16/18 positive and unable to reflex from the same sample, colposcopy plus cytology are acceptable
Screening Special Populations
- HIV-infected and immunocompromised:
- Start cytology alone within 1 year of onset of sexual activity or within 1st year of HIV diagnosis, no later than 21
- Under 30 years old:
- Need to repeat cytology in 1 year after normal Pap; after 3 consecutive normal annual Paps, then can screen every 3 years
- Over 30 years old:
- Need to do cytology alone or co-testing; co-testing can go to every 3 years after 1 negative co-test
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Description
This quiz covers medical procedures and guidelines for abortion, including lab tests and ultrasound requirements, as well as initiating contraception after abortion.
