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