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Questions and Answers
A patient presents for a medication abortion at 10 weeks gestation. She has a history of anemia. What lab is indicated in this scenario?
Which of the following is a contraindication for medication abortion?
A patient presents for a medication abortion at 8 weeks gestation. She has a regular menstrual cycle and no history of ectopic pregnancy. What is the most appropriate next step in her care?
A patient presents for a medication abortion at 11 weeks gestation. She has irregular menses and her last menstrual period (LMP) is unclear. What is the most appropriate next step?
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A patient presents for medication abortion with heavy vaginal bleeding and a positive urine pregnancy test. Her estimated gestational age is 8 weeks. What should be the first step in her management?
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When is it appropriate to initiate an IUD after a medication abortion?
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A patient presents for a medication abortion and wants to begin contraception immediately. Which contraceptive method can be started at the time of mifepristone administration?
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A patient has completed a medication abortion. During her follow-up visit, she reports no further symptoms of pregnancy. What is the most likely reason for this?
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What is the percentage of abortions performed under 13 weeks gestation?
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Which of the following is NOT an advantage of medication abortion?
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What action should be taken if a patient decides to continue their pregnancy?
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Pregnancy-associated mortality rates are particularly higher among which demographic?
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Which of the following statements regarding first trimester abortions is true?
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What percentage of abortions are performed after 13 weeks gestation?
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What is a recommended pre-procedure step for medication abortion?
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What is one of the critical components of providing options counseling for pregnancy decisions?
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What is the effectiveness rate of aspiration abortion?
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Which of the following is a disadvantage of aspiration abortion?
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How long does the aspiration abortion procedure typically last?
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What effect does the absence of a gestation sac have on follow-up after a medical abortion?
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Which of the following is NOT a comfort measure during aspiration abortion?
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What is the recommended action regarding contraception immediately following an aspiration abortion?
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Study Notes
Module 1: Contraceptives, Pregnancy Options, Cervical Cancer Screening
- Pregnancy-associated mortality rate is 32.9 per 100,000 live births, with higher rates among BIPOC populations.
- Pregnancy mortality is elevated in states with strict abortion laws.
- Approximately 7 million women are hospitalized annually due to unsafe abortions.
- Use all options counseling to foster a supportive environment while exploring pregnancy-related decisions with empathy and curiosity.
- Pregnancy options include: terminating pregnancy, carrying it to term, medication abortion, procedural abortion, parenting, and adoption.
- For patients who choose to continue their pregnancy, initiate prenatal vitamins, refer for prenatal care, educate on warning signs, and assess needs related to nutrition, housing, finances, and childbirth education.
- About 92.7% of abortions occur within the first trimester, with only 7.2% after 13 weeks.
- Two key types of abortion are medication abortion and aspiration, both performed in the first trimester.
- First trimester abortions do not increase risks of infertility, ectopic pregnancy, miscarriage, birth defects, preterm delivery, breast cancer, or mental health disorders.
- Medication abortion can be performed up to 77 days from the last menstrual period (LMP) and has a 95% effectiveness rate.
- Advantages of medication abortion include less invasiveness, increased autonomy, and available telehealth options.
- Disadvantages of medication abortion comprise prolonged bleeding, cramping, and the potential need for surgical intervention if medication fails.
- The medication abortion regimen includes mifepristone (200 mg) followed by misoprostol (800 mcg) taken 24-48 hours later, with specific dosing for pregnancies between 9-11 weeks.
- Mifepristone blocks progesterone, leading to cervical ripening, while misoprostol promotes uterine contractions and expulsion.
- Patients should expect cramping and bleeding within 4-24 hours post misoprostol; NSAIDs or opiates can be provided for pain relief.
- Medication abortion requires verification of a positive urine pregnancy test, and estimated gestational age must be less than 77 days.
- Contraindications for medication abortion include the presence of an IUD, allergies to medications, chronic adrenal insufficiency, and certain co-morbidities.
- Labs may include hematocrit and hemoglobin for patients over 10 weeks or with anemia history, Rh status check, and quantitative beta-hCG measurement if necessary.
- Criteria for ultrasound include suspected ectopic pregnancy, uncertain LMP, irregular menstrual history, and vaginal bleeding.
- For post-abortion contraception, an implant can be placed immediately, while pills, patches, or rings can be started the day after mifepristone; IUDs are placed after confirming abortion completion.
- Assessing abortion completion can involve follow-up visits or evaluating bleeding patterns and measuring hCG levels, ensuring an 80% decrease within a week.
- A negative urine pregnancy test four weeks after mifepristone indicates successful abortion; a positive result necessitates further evaluation.
- Aspiration abortion is 99% effective, performed rapidly, and requires no follow-up; suitable for later-stage abortions (up to 14 weeks).
- Disadvantages of aspiration abortion include the need for pelvic instrumentation and less control for the patient.
- Analgesia options for aspiration abortion include NSAIDs and varying levels of sedation, while comfort measures can enhance patient experience.
- The aspiration procedure typically lasts 5-10 minutes and allows for immediate contraception placement afterward.
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Description
This study guide covers various topics related to reproductive health, including contraceptives, pregnancy options, cervical cancer screening, and more. It is designed to help students achieve 100% recall on their final exam.
