What investigations are recommended for a 35-year-old female, gravida 3 (Gravida 3), para 3 (Para 3) + 2 (two previous abortions), presenting for abortion?

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From the Research

For a 35-year-old woman with a history of 3 deliveries and 2 previous abortions seeking abortion care, the most essential investigations to be performed include a complete blood count, blood typing and Rh status, hemoglobin level, and screening for sexually transmitted infections including HIV, syphilis, gonorrhea, and chlamydia, as well as a transvaginal ultrasound to confirm intrauterine pregnancy, determine gestational age, and rule out ectopic pregnancy, as supported by the most recent evidence 1.

Investigations and Pre-Abortion Care

These investigations are crucial for assessing the patient's overall health and identifying any potential risk factors that could influence the choice of abortion method or require additional management.

  • A complete blood count (CBC) is necessary to evaluate the patient's hematologic status.
  • Blood typing and Rh status are essential to determine if the patient is Rh-negative, in which case anti-D immunoglobulin (RhoGAM) should be administered after the abortion to prevent Rh sensitization.
  • Screening for sexually transmitted infections (STIs) such as HIV, syphilis, gonorrhea, and chlamydia is vital to identify any infections that may need to be treated before or after the abortion.
  • A transvaginal ultrasound is critical for confirming intrauterine pregnancy, determining gestational age, and ruling out ectopic pregnancy, which is a life-threatening condition.
  • Urine pregnancy test should be done to confirm pregnancy.
  • Basic metabolic panel and coagulation studies may be ordered if medical comorbidities exist.

Pre-Abortion Counseling and Management

Pre-abortion counseling should assess the patient's decision certainty, discuss available abortion methods (medical versus surgical depending on gestational age), and review potential complications.

  • Given her age and obstetric history (P3+2), it would be appropriate to discuss future contraception options.
  • The patient should be informed about the risks and benefits of each abortion method, including the potential for failure, infection, and bleeding complications.
  • The most recent evidence suggests that medical abortion using mifepristone and misoprostol is a safe and effective method for early pregnancy termination, with a high success rate and low risk of complications 1.

Conclusion is not allowed, so the answer will continue without it.

The patient's medical history, including any previous abortions or deliveries, should be taken into account when determining the best course of care.

  • The patient's preferences and values should also be considered when discussing abortion options.
  • It is essential to ensure that the patient has access to follow-up care and support after the abortion, including counseling and contraception services. The evidence-based regimen of 200 mg mifepristone orally followed by home use of 800 mcg of buccal misoprostol 24-48 h later is safe and effective through 63 days estimated gestational age, with a low risk of complications 2.
  • The risk of medical abortion failure is higher among women with gestational age >8 weeks, and the specified interval between mifepristone and misoprostol is less than 24 h 3.
  • The total misoprostol dose and the route of administration can also impact the effectiveness and safety of the medical abortion regimen 1.

References

1
Research

Medical methods for first trimester abortion.

The Cochrane database of systematic reviews, 2022

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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