Medicine an Surgery notes

Apr 24th, 2015
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METHOD FOR INDUCED ABORTIONFirst trimester abortionVacuum curettageMedical abortion in the first trimesterSecond trimester abortionDilation and evacuationLabor induction methodsFetal death in uteroSelective fetal reductionMethods for abortion in the first trimesterVacuum curettageEpidemiology The most common method of abortion in the United StatesBefore 13 weeks: Suction or vacuum curettageAfter 13 weeks: Dilation and evacuation (D&E)Procedure Antibiotics Marked reduction in postabortal infectionTetracycline, doxycycline, minocycline Broad spectrum of antimicrobial effect Oral absorptionPain reliefParacervical block 10-20mL of 1% lidocaineDeep injection into the cervical stroma at multiple siteAddition of 2-4 units of vasopressin to the anesthetic solution Reduces blood lossPrevent postabortal uterine atonyNonsteroidal anti-inflammatory drugs: Preoperative administration -> modest reduction in painConscious sedation: Intravenous midazolam 1-3mg and fentanyl 50-100ugThe necessary dilatation of the cervixMechanical cervical dilation with tapered cervical dilatorsHygroscopic dilators - laminaria: Reduces risk for perforation or cervical lacerationProstaglandins - misoprostol: 400ug vaginal dose, 3-4 hours before procedure, Minimal side effects, little expenseFor complete abortion and early diagnosis of ectopic pregnancyPreoperative ultrasonographyCareful inspection of the aborted tissueFollow up with serial hCG titerManua

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