EXERCISES: INCREMENTAL EXPANSION OF ABORTION CARE

EXERCISE 1. Feeling about abortions with advancing gestational ages and your role

In spite of our efforts to be objective, we all hold personal values and belief systems that can influence how we respond to patients. These exercises can help you explore your values about pregnancy options with advancing gestational ages in the context of professional judgments you may be called to make. In multiple global settings, participants who undertake abortion values exploration show improved knowledge, attitudes, and behavioral intentions with regards to abortion care (Turner 2018).

1. Depending on your state’s legal status of abortion, how comfortable are you being involved in abortion with advancing gestational ages in the following ways?
   1. Referring for an abortion
   2. Observing or performing ultrasound procedural guidance
   3. Looking at pregnancy tissue (i.e. products of conception)
   4. Assisting or performing abortion
   5. Taking on a medically complex patient for care (especially given that if coming from a ban state, they may have minimal patient work-up and risk stratification).

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2. What is your biggest concern about providing abortions beyond 12-14 weeks EGA?

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3. If no alternative abortion services were accessible, what kind of patient hardship might motivate you to offer information, referral or services (to the extent of legality in your state)?

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4. If you are trying to assist a patient find appropriate abortion services (or referral) beyond ≥ 14 weeks EGA, what might be some key steps and precautions?

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EXERCISE 2: Understanding patients’ reasons or situation

1. Describe why pregnant people might present beyond ≥ 14 weeks EGA for abortion care?

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2. What kind of provider and staff support might be helpful in abortion care settings that regularly provide care beyond the first trimester?

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3. How might abortion bans contribute to delays and further disparities?

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EXERCISE 3: Technical considerations, skills, and cases [SG1]

1. In addition to the standard screening and preparations for abortion up to ≥ 14 weeks, what other screenings or plans might you need for an abortion ≥ 14 weeks?

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2. A 30 year-old G3P2 patient at 17 weeks is undergoing an ultrasound-guided D&E procedure, and experiences localized pain as you make a lateral instrument pass which feels deeper than previous passes, and without fundal landmarks felt previously. How would you proceed?

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3. For a 22 year-old G1P0 patient at 16 weeks, you are completing an ultrasound-guided, and after easily removing most of the pregnancy, you have significant difficulty removing the calvarium. What techniques might you consider to safely complete the procedure?

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4. What overarching considerations and information might you need for a medically complex patient beyond ≥ 14 weeks that appears at your clinic?

See Teaching Points