Pregnancy Termination

00:00
APGO educational topic number 34
00:02
pregnancy termination unintended
00:04
pregnancies refer to mistimed
00:06
unwanted or unplanned pregnancies 50% of
00:10
pregnancies in the United States are
00:11
unintended and 43% of these pregnancies
00:14
end in terminations 3 out of 10 women
00:17
will have a pregnancy termination by the
00:19
age of 45 the objectives of this video
00:22
are to provide non-directive counseling
00:23
to patients surrounding pregnancy
00:25
including unintended pregnancy to list
00:28
surgical and non-surgical methods of
00:30
pregnancy termination to identify
00:32
potential complications of pregnancy
00:33
termination and to describe the public
00:36
health impact of the legal status of
00:37
abortion there are many terms used to
00:40
describe a termination of pregnancy
00:41
induced abortion therapeutic abortion
00:44
and elective abortions all describe a
00:46
termination of pregnancy pregnancy
00:48
termination can occur in the first or
00:50
second trimester of pregnancy the first
00:52
trimester is defined as up to
00:53
approximately 12 weeks gestation and the
00:55
second trimester is defined as
00:57
approximately 13 weeks to 26 weeks
00:59
termination of pregnancy is the most
01:01
regulated medical procedure in the
01:03
United States each state has different
01:05
laws and regulations about abortions
01:07
including how late in the pregnancy and
01:09
abortion can be performed a summary of
01:11
these laws can be found at the
01:13
Guttmacher Institute website when caring
01:15
for women with unintended pregnancy it
01:17
is important to provide non-directive
01:19
counseling the American College of
01:22
Obstetricians and Gynecologists
01:23
recommends physicians who are not
01:25
willing to provide specific reproductive
01:27
services should have referral processes
01:29
in place to provide for transfer of care
01:31
in a timely manner physicians should
01:34
also give advance notice of their
01:35
personal moral commitments and should
01:37
not advocate or argue their positions to
01:39
patients the American Academy of Family
01:41
Physicians states that a woman who is
01:43
considering an elective abortion should
01:45
be adequately informed about the
01:47
potential health risks of abortion and
01:49
continued pregnancy the physician should
01:51
provide the patient with information
01:53
about financial and other assistance
01:55
available to both her and the child the
01:57
availability of licensed or regulated
01:59
adoption agencies if she chooses not to
02:01
keep the child the availability of safe
02:04
legal abortion services if she chooses
02:06
not to continue the pregnancy or the
02:09
physician should identify resources
02:10
where such information can be obtained
02:13
medical termination of pregnancy is one
02:15
of the options in the first trimester it
02:17
is most commonly used up to 63 days or
02:19
nine weeks of gestation remember that we
02:22
use menstrual dating for pregnancies so
02:24
this is the 63 days after the first day
02:27
of her last menstrual period 25% of
02:30
terminations prior to nine weeks
02:31
estimate gestational age our medical
02:33
terminations the combination medication
02:36
regiment of mytha Prestone and
02:37
misoprostol are most commonly used in
02:39
the United States and Western Europe
02:41
Miha Priss tone is a progesterone
02:44
antagonist and stops the growth of the
02:45
pregnancy and misoprostol is a
02:47
prostaglandin analogue that causes
02:49
uterine cramping and expulsion of the
02:51
products of conception
02:53
this combination regimen is 92%
02:56
effective up to 49 days gestation with a
02:59
medical termination women should be
03:01
counseled that they will experience
03:02
bleeding that is heavier than a menses
03:04
and cramping at home complications from
03:06
medical terminations are rare and
03:08
include bleeding and the need for urgent
03:10
surgical interventions approximately 1%
03:12
of women will need an urgent surgical
03:14
curettage after a medical termination
03:16
infection and the need for narcotic pain
03:18
medications are also rare complications
03:20
remember that for all terminations of
03:23
pregnancy the woman’s RH type should be
03:24
determined and rhogam should be
03:26
administered to Rh negative women let’s
03:28
move now to surgical termination of
03:30
pregnancy for this procedure the cervix
03:33
is progressively dilated and the
03:35
products of conception are aspirated
03:37
from the uterus vacuum aspiration and
03:40
dilation and curettage are the most
03:41
commonly utilized surgical modalities
03:43
they are equally effective with similar
03:45
complication rates second trimester
03:48
terminations are more rare 6.2 percent
03:50
of terminations the United States took
03:52
place between 13 and 15 weeks and 4%
03:54
occurred after 16 weeks circumstances
03:57
leading to a second trimester
03:59
termination of pregnancy include delayed
04:01
recognition of pregnancy a delay in
04:03
obtaining insurance or referral and
04:05
difficulty finding a provider poverty
04:08
lower education level and having
04:10
multiple disruptive life events have
04:12
been associated with higher levels of
04:13
seeking a second trimester determination
04:15
in addition adolescents are more likely
04:18
to obtain abortions later in pregnancy
04:19
among women under the age of 15 one out
04:22
of five abortions is performed after 13
04:25
weeks both medical and
04:26
of Labor and the surgical dilation and
04:28
evacuation procedures are available for
04:30
second trimester determinations over all
04:33
abortions are very safe procedures with
04:35
less than 1% risk of major complications
04:37
these complications include infection
04:40
bleeding and damage to the uterus
04:42
comprehensive contraception counseling
04:44
is a part of abortion counseling to
04:45
prevent future unplanned pregnancies we
04:48
will conclude by discussing the public
04:50
health impacts of the legalization of
04:52
abortion between 1966 and 1969 women had
04:56
access to legal abortion services in
04:58
eleven states in 1973 the Supreme
05:01
Court’s decision in Roe versus Wade
05:03
legalized abortion throughout the
05:05
country it is very difficult to know
05:08
exactly how many abortions were
05:09
performed prior to Roe vs. Wade but the
05:12
characteristics of women obtaining legal
05:14
abortions changed greatly after the
05:15
ruling the proportion of women having
05:18
abortions who were non-white increased
05:20
the proportion of women having abortions
05:22
who were unmarried increased and the
05:25
proportion of abortions performed
05:27
earlier in the pregnancy increased prior
05:29
to 1970 one out of four abortions was
05:32
performed at 13 weeks gestation or later
05:34
10 years later that proportion changed
05:36
to 1 out of 10 the hospitalization of
05:40
women with complications from illegal
05:42
abortions decreased gradually after Roe
05:44
versus Wade this concludes the aapko
05:46
video on pregnancy termination we have
05:48
reviewed surgical and non-surgical
05:49
methods of pregnancy termination discuss
05:52
potential complications and describe the
05:54
public health impact of the legalization
05:56
of abortion
06:09
you