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(1) CONTROL BY HYPOTHALAMUS Inhibited by combinationof estrogen andprogesteroneStimulated by highlevels of estrogen

Hypothalamus

Releasinghormone

Anterior pituitary

FSH LH

(2) PITUITARY HORMONESIN BLOOD LH peak triggers

ovulation andcorpus luteumformation

LH

FSH

FSH LH

(3) OVARIAN CYCLE

Growingfollicle

Maturefollicle

OvulationCorpusluteum

Degeneratingcorpusluteum

Pre-ovulatory phase Post-ovulatory phase

Estrogen Progesteroneand estrogen

(4) OVARIAN HORMONESIN BLOOD

EstrogenProgesterone

Estrogen Progesteroneand estrogen

(5) MENSTRUAL CYCLE

Endometrium

Menstruation Days

ABORSI

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Medical Abortion

• Mifepristone (RU486) – analogue of progestin norethindrone – strong affinity for the progesterone receptor,

acting as an antagonist – a single oral dose given to women 5 weeks or

less produces abortion in 85% of cases

Medical Abortion - politics

• RU486 - Mifepristone – developed in 1980’s – approved for use by French government 1988

• one day later manufacturer withdrew it from the marketsuccumbing to international boycott

• French government ordered redistribution – Prohibited in US during Reagan and Bush – Ban lifted by Clinton, clinical trials, preliminary FDA

approval 9/96 – Final approval stalled secondary to inability to

manufacture and distribute until 9/2000

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Medical Abortion - politics

• RU486 - Mifepristone – developed in 1980’s – approved for use by French government 1988

• one day later manufacturer withdrew it from the marketsuccumbing to international boycott

• French government ordered redistribution – Prohibited in US during Reagan and Bush –

Ban lifted by Clinton, clinical trials, preliminary FDAapproval 9/96 – Final approval stalled secondary to inability to

manufacture and distribute until 9/2000

Surgical vs. Medical: pro vs. conProvider perspective:

• Less skill needed toprovide

• Methotrexate alsotreats ectopicpregnancy

• Increased anxiety re:off site management

• More unscheduledcare: calls, ER visits

• Need to guard againstunnecessaryintervention

• Limited to 49 daysLMP

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Complications - rates

• Varies as a function of the gestational agethey are performed

– Major complications:• 0.25% < 7 weeks• 1% < 12 weeks• 2% over 12 weeks

Complications - immediate

• Complications of local anesthetic• Cervical shock• Cervical lacerations•

Uterine perforation• Hemorrhage• Post abortal syndrome

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MATERNAL RISKS WITHTWINS

• Increased minor complaints ofpregnancy

•

Increased risk of miscarriage• Increased anaemia, pre-term delivery• Hypertension• Antepartum Haemorrhage

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MATERNAL RISKS WITH

TWINS (contd.)• Hydramnios• Need for hospitalisation• Single fetal death in twins• Operative Delivery• Caesarean Section• Postpartum Haemorrhage

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