••• Chapter 60^ Miscarriage, Recurrent Miscarriage, and Pregnancy Termination^605
❍ What percentage of SABs become infected?
1% to 2%.
❍ What is the risk of death from abortion?
0.6/100,000 for elective abortions.
❍ Nonsurgical methods can be used to terminate pregnancies at which gestational ages?
<7 to 9 weeks.
❍ Surgical methods are used to terminate pregnancies at which gestational ages?
<7 to 23 weeks typically; however, the upper gestational limit varies according to each state.
❍ Are prophylactic antibiotics recommended for pregnancy termination?
ACOG recommends use of 100 mg doxycycline prior to procedure followed by 200 mg post-op.
❍ What are the most common complications of surgical abortions?
Less than 1% of cases will develop hemorrhage, fever, infection, and retained products of conception.
❍ What is the optimal management for postabortal pain, bleeding, and fever?
Oral antibiotics and ergot medications followed by repeat uterine evacuation performed under local anesthesia in
an ambulatory center, if retained products are suspected.
❍ How effective is RU 486 when used with misoprostol in first-trimester medical pregnancy termination?
Ninety-seven percent had successful pregnancy termination if given by 49 days from the last menstrual cycle.
❍ How effective is methotrexate when used with misoprostol in first-trimester medical pregnancy termination?
Ninety-six percent had successful pregnancy termination if given by 63 days from the last menstrual cycle.
❍ What agent is commonly used for multifetal, selective reduction to prevent cases of extreme prematurity?
Intracardiac KCl (0.05 to 3 mL).
❍ What percentage of abortions are performed within the first 12 weeks of pregnancy?
90%.
❍ Why is local anesthesia preferable to general anesthesia with pregnancy termination?
General anesthesia is associated with greater risk of perforation, visceral injury, hemorrhage, and death.
❍ What morbid events can occur with the use of local anesthetics?
Convulsions, syncope, and fever have been associated with the use of local anesthetics.
❍ What is the risk of surgical perforation in the first-trimester patient?
9.4/100,000 induced abortions.