Abortion
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of other pelvic surgical procedures. Gastroenterologists offer a variety of procedures for the diagnosis and treatment of abdominal pain including upper and lower endoscopy (insertion of a flexible tube containing a camera into the mouth or rectum) of the digestive and pancreas–biliary tracts, motility studies, and pH (acid) monitoring. Chronic abdominal pain is often difficult to diagnose and treat. At times, the involvement of an anesthesiologist or other pain management professional is helpful. They are skilled in the management of pain with medications, therapeutic nerve blocks (injection of an anesthetic agent near a specific nerve or group of nerves), and counseling. If there appears to be a psychiatric component to abdominal pain, referral to a mental health professional is appropriate. Chronic functional abdominal pain syndromes require a combined approach of education, reassurance, dietary changes, medications, and, at times, behavioral therapies (e.g., relaxation and biofeedback techniques). SEE ALSO: Chest pain, Chronic pain, Nausea, Pelvic pain, Peptic ulcer disease
Suggested Reading Pasricha P. J., et al. (1999). Abdominal pain. In T. Yamada, D. H. Alpers, L. Laine, C. Owyang, & D. W. Powell (Eds.), Textbook of gastroenterology (3rd ed., pp. 795–815). Philadelphia: Lippincott, Williams & Wilkins.
Suggested Resources U.S. National Library of Medicine: http://www.nlm.nih.gov/medline/ ency/article/003120.htm
SAPNA THOMAS MARGARET F. KINNARD
Abortion According to the U.S. Centers for Disease Control and Prevention, 1.18 million legal abortions were performed in the United States in 1997. The risk of death from legal abortion is 0.4 per 100,000 induced abortions. Most abortions are performed surgically by vacuum curettage. Medical abortion (abortion induced by the use of medications) has recently become an option in this country. In most medical abortions, expulsion of the pregnancy occurs at home. About 1% of women require surgical evacuation to complete the process.
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Abortion
TECHNIQUE FOR SURGICAL ABORTION Surgical abortion can be performed in an office or hospital setting. The success rate of surgical termination is 99%. It is usually a single-step process that requires one visit to the practitioner. In early pregnancy (less than 7 weeks), a small flexible plastic cannula (5–6 mm) is inserted into the uterus under sterile conditions. Plastic syringes (50 ml) are used as the vacuum source and the uterine contents are suctioned out. Adequate pain relief is provided by injecting local anesthetic into the cervix and administering intravenous sedation and analgesics. After 7 weeks, a larger rigid plastic cannula (8–10 mm) is used with an electric pump as the vacuum source. After 18 weeks, a dilation and evacuation (using larger bore cannulae) usually must be performed under general anesthesia. Typically, seaweed (laminaria) or a synthetic version is inserted into the cervix to prepare it for the procedure. The seaweed absorbs water, swells, and gently dilates the cervix over a 24-hour period. This
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