Medicine an Surgery notes

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Surgical AbortionDavid Blair Toub, M.D.Dept. of Obstetrics and GynecologyPennsylvania HospitalIntroduction1973: Roe v. Wade; Trimester Approach Number of Abortions Stable or Decreasing ~ 1/3 of Women 15-44 Undergo Abortion Abortion 10-11x Safer than ContinuingPregnancy, 2x Safer than PCN Injection 91% 1st TM, 9% 2nd TM, .01% 3rd TM 1965: Illegal Ab = 17% of Maternal DeathsPatient EvaluationCounseling, ACA (in PA) Pregnancy Test History LMP, Medical Risk Factors PEx Confirmation of Gestational Age T+Rh, Hct U/S if Significant Discrepancy on Examor Recent Vaginal BleedingTechniques 14 Weeks: Suction Curettage Medical Abortion ( 56 days LMP) 14-24 Weeks and Beyond: Dilatation and Evacuation (D+E) Intact D+E (D+X) Labor Induction Methods (Prostaglandins) Amnioinfusion (HS, Urea, Prostaglandins)Cervical DilatationMechanical: Done at Time of D+E Convenient for Patient May be Uncomfortable Increased Risk of Perforation(Compared with Osmotic Dilators)Cervical DilatationOsmotic Dilators (e.g. Laminaria) Increased Time, Inconvenience Less Pain, Decreases Perforation Risk Examples: Laminaria japonicum, L. digitatum DilapanSynthetic LamicelSuction CurettageOffice, Clinic or Hospital Setting Local (Paracervical Block) or IV Sedation General Anaesthesia Increases Risk Prophylactic Doxycycline Decr

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