Monthly Archives: December 2007

High-Dose Oxytocin. Hypertonic Saline. Hysterotomy and Hysterectomy

High-Dose Oxytocin Oxytocin in sufficient doses can be effective as a primary abortifacient in the mid-trimester. Fifty units is given in 500 mL of 5% dextrose and normal saline over a 3-hour period. After 1 hour of rest, the oxytocin

Fetal Death In Utero. Intrauterine Prostaglandins. Systemic Prostaglandins

Fetal Death In Utero Fetal death in utero can be managed with D&E, provided that the surgeon is familiar with the procedure. Vaginal prostaglandin E2 is highly effective for this problem, usually producing fetal abortion in about 10 hours, but often

SECOND-TRIMESTER ABORTION

Most abortions are performed before 13 menstrual weeks. Later abortions are generally performed because of fetal defects, maternal illness, or maternal age. Younger women are much more likely to request abortion after 12 weeks. Dilation and Evacuation Transcervical instrumental evacuation of

MEDICAL ABORTION IN THE FIRST TRIMESTER

Mifepristone (RU 486) is an analogue of norethindrone with high affinity for progesterone receptors. It acts as a false transmitter and blocks natural progesterone. It can effectively induce an abortion in an early gestation after a single oral dose. The

Ectopic Pregnancy, Incomplete Abortion, and Failed Abortion

Early detection of ectopic pregnancy, incomplete abortion, or failed abortion is possible if the physician performing the operation carefully examines the specimen immediately after the abortion. The patient may have an ectopic pregnancy if no chorionic villi are found. To

Perforation. Hemorrhage. Hematometra

Perforation The risk of perforation is less than 1 in every 1,000 first-trimester abortions. It increases with gestational age and is greater for parous women than for nulliparous women. The use of laminaria reduces the risk. Perforation is best evaluated

Complications. Anesthesia. Cervical Shock

Complications The most common postabortal complication is a triad of pain, bleeding, and low-grade fever. Often, this complication can be managed initially by administration of oral antibiotics and ergot preparations. However, most cases are caused by retained gestational tissue or

FIRST-TRIMESTER VACUUM CURETTAGE

Beyond 7 menstrual weeks of gestation, larger cannulas and vacuum sources are required to evacuate a pregnancy. This procedure, standard vacuum curettage, is the most common method of abortion in the United States. By recent convention, procedures performed before 13

Pregnancy Termination

In the United States, about 1.5 million legal abortions are performed each year; 90% of these procedures are performedin the first trimester of pregnancy. Teenagers and women older than age 40 years have the highest abortion rates.Before 16 weeks of

Ovulatory Bleeding: Menorrhagia. Ovulatory Bleeding: Not Cycle Related

Ovulatory Bleeding: Menorrhagia Cheap Singulair Menorrhagia is defined as menstrual blood loss in excess of 80 mL per menstrual period. However, objective measurement is not practical, so the diagnosis must be made indirectly. Complicating matters is the poor association between

Patient Evaluation. History of the Present Illness

Patient Evaluation History of the Present Illness The history establishes the woman’s baseline menstrual cycle pattern and characterizes in detail the changes that led to the current consultation. The latter should include when the abnormal bleeding began; the characteristics of

Differential Diagnosis of Abnormal Bleeding

Pregnancy Ectopic pregnancy Trophoblastic disease Abnormal intrauterine pregnancy Anovulatory Transient anovulation Polycystic ovary syndrome Androgen disorder Ovarian tumor Adrenal tumor Thyroid disorder Ovulatory: Menorrhagia Idiopathic Endometrial polyp Submucous leiomyoma Coagulopathy (yon Willebrand’s disease, iatrogenic cause, hematologic malignancies) Intrauterine device Ovulatory: