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Gynaecology > 1: Fertility Control - TOP > Flashcards

1: Fertility Control - TOP Flashcards

1
Q

What proportion of women will have had a TOP by age 45-years

A

1/3

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2
Q

What two acts govern termination of pregnancy

A
  1. The abortion act (1967, revised 2000)

2. Human Fertilisation and Embryo Act (1990)

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3
Q

what are the. 5 clauses of the abortion act (2000)

A

A. Risk to mother’s life
B. Risk of grave physical or mental injury to mother
C. Risk of physical or mental injury to mother and foetus is less than 24W
D. Risk of physical of mental injury to other children of the mother and foetus is less than 24W
E. Child is likely to be born with serious mental or physical disorder causing them to be severely handicapped

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4
Q

what is the time-limit for clauses A, B and E

A

No time limit

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5
Q

what is the time limit for clauses C and D

A

24W

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6
Q

what document must doctors sign to confirm criteria have been met

A

HSA1

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7
Q

if more than 24W where must TOP be carried out

A

NHS Hospital

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8
Q

explain obligation of doctors for TOP as set by GMC

A
  • Do not let prejudice impact treatment

- Can refuse under conscientious objection, but refer to doctor who will

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9
Q

explain TOP in patients under 16-years

A

Encourage to involve parents but can under Fraser competence

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10
Q

explain what should be given before TOP

A 
Counselling 
US - confirm gestation 
STI test
Antibiotic prophylaxis 
Anti-D if rhesus negative
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11
Q

what medications are given in a medical termination

A

mifepristone and misprostol

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12
Q

when is medical terminations effective

A

> 6W

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13
Q

what are medical terminations typically used

A

second-trimester terminations

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14
Q

when is the second trimester

A

13-28W

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15
Q

if an early TOP what follow-up should be arranged

A

US scan at 2W to confirm success

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16
Q

what is given alongside mifepristone and misoprostol for medical termination

A

Narcotics or NSAIDs for analgesia

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17
Q

what defines an early medical termination

A

TOP before 9W

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18
Q

explain an early medical termination

A

Give mifepristone (200mcg) and then misoprostol (400mcg) 24-48h later

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19
Q

what should be done medical termination 9-13W

A

Give mifepristone (200mcg) and misoprostol (800mcg) 36-48h later

20
Q

what should be done for medical termination 13-24W

A

Give mifepristone (200mcg) and misoprostol (800mcg) 36-48h later

21
Q

what type of medication is mifepristone

A

anti-progesterone

22
Q

what is the MOA of mifepristone

A
  1. Uterine contractions
  2. Increases receptiveness uterus to PGs
  3. Placental bleed
23
Q

what is misoprostol

A

PGEI analogue

24
Q

what is the MOA of misoprostol

A

Uterine contractions

25
Q

what are the two surgical methods of TOP

A
  1. Suction

2. Dilation and Evacuation

26
Q

when do individuals need cervical dilation

A

<18-years or >10W gestation

27
Q

what is used to cause cervical dilation prior to surgical TOP

A

gamoprost or misprostol

28
Q

what is gameprost

A

PGEI analogue

29
Q

when is misoprostol used as a cervical dilator

A

Up to 18W

30
Q

what is used above 14W as cervical dilator

A

Osmotic dilators

31
Q

If surgical TOP is performed >13W who should be performing it

A

Consultant - due to higher risks of perforation, bleeding and retained products

32
Q

Explain surgical management of TOP less than 7W

A

Do NOT use suction. Medical management preferred

33
Q

What method is used 7-13W for surgical management of TOP

A

Suction

34
Q

What is used >13W for surgical management TOP

A

Dilation and Evacuation

35
Q

What are risks of higher gestation TOP

A
  • Bleeding
  • Uterine rupture
  • Retained products
36
Q

if gestation more than 21+6 what should happen to the foetus if TOP

A

Give intracardiac postassium chloride and foetus must be delivered

37
Q

what is used to cause TOP if foetus is more than 21+6

A

3mL 15% intracardiac potassium chloride

38
Q

what must be confirmed after intracranial potassium chloride

A

US to confirm systole

39
Q

if a foetus is more than 24W what does the foetus count as

A

stillbirth - needs a death certificate

40
Q

what are complications of TOP

A 
Infection 
Haemorrhage 
Uterine perforation 
Uterine rupture 
Failure 
Retained products conception
41
Q

what causes higher failure rates medical or surgical TOP

A

Medical TOP

42
Q

what is used to prevent infection in TOP

A

Azithromycin and Metronidazole

43
Q

how does risk of haemorrhage change

A

Increases with gestation

44
Q

what can cause uterine rupture

A

Medical TOP - mid gestation

45
Q

what can cause uterine perforation

A

Surgical TOP

46
Q

if TOP less than 20W and rhesus negative what is given

A

250IU anti-D

47
Q

if TOP more than 20W and rhesus negative what is given

A

500IU anti-D

Gynaecology (22 decks)

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