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May 16, 2011 Nursing 330 Human Reproductive Health IMPORTANT DATES  Mon, May 23, 2011    Guest Speaker, American Cancer Society Mon, May 30, 2011 – Holiday Mon, June 6, 2011 – Final Exam     7:00pm – 10pm Cumulative 100 questions, 2 points each Study Guide will be posted by Fri, May 27, 2011 Abortion Abortion  Spontaneous abortion    aka miscarriage Loss of baby before 20 weeks of pregnancy Induced abortion   Surgical Drug-based Surgical Method  Vacuum Aspiration   First trimester method Dilation and Extraction (D & X)  Late surgical method Drug-Based Methods  Mifepristone (RU 486) –Injection, 0rally  An anti-progesterone    Approved by FDA in September 2000 for abortion    prevents progesterone from making uterine lining hospitable for implantation If fetus is already implanted, causes the uterus to shed its lining and, along with it, the fertilized fetus As an alternative to surgical procedure Effectiveness is increased if used with another drug, Misoprostol (95-98%) Most effective within 7 weeks of fertilization Drug-Based Methods (cont)  Methotrexate –Injection; orally (rarely)   Prevents cell division and multiplication Can be used to induce an abortion     Effectiveness is increased if used with another drug, Misoprostol (95%) Approved by FDA for treatment of cancer, arthritis and psoriasis Most effective within 7 weeks of fertilization Misoprostol – orally or vaginally   Legal Drug used in conjunction with above drugs The second drug used to complete the abortion procedure    Taken a day or two after administration of the first drug Causes the uterus to contract and expel its contents Approved in the US for coating the stomach of people who take stomach-irritating anti-inflammatory drugs. Abortifacient   A method or substance that causes a fertilized egg that has implanted in the uterine wall or fetus to be expelled. Which of the drug-based methods is an abortifacient? Incidence of Abortions     Nearly half of pregnancies among American women are unintended, and four in 10 of these are terminated by abortion. Twenty-two percent of all pregnancies (excluding miscarriages) end in abortion. In 2005, 1.21 million abortions were performed, down from 1.31 million in 2000. From 1973 through 2005, more than 45 million legal abortions occurred. Each year, about two percent of women aged 15-44 have an abortion; 47% of them have had at least one previous abortion. Source: Perspectives on Sexual and Reproductive Health When women have abortions Source: Guttmacher Institute Cost  Surgical  In 2005, the cost of a non-hospital abortion with local anesthesia at 10 weeks’ gestation ranged from $90 to $1,800; the average amount paid was $413 (Source: Perspectives on Sexual and Reproductive Health)  Drug-based  most providers do charge more for this method Abortion and the Law  Roe v. Wade  1973 Supreme Court decision stating    1st trimester abortions cannot be regulated by states and the decision to abort is between woman and physician 2nd trimester abortions permitted when mental or physical health of mother at risk 3rd trimester abortions allowed when life of mother at risk California Law  California does not have any of the major types of abortion restrictions – such as waiting period, mandated parental involvement or limitations on publicly funded abortions – often found in other states. Source: Alan Guttmacher Institute The Pro-Life and Pro-Choice Controversy   Anti-abortion (Pro-life) position Pro-choice position