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A - MSRA Gynaecology [8] > [12] Termination Of Pregnancy > Flashcards

[12] Termination Of Pregnancy Flashcards

1
Q

What is termination of pregnancy?

A

A medically directed miscarriage prior to independent viability, using pharmacological or surgical means

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2
Q

What is termination of pregnancy commonly referred to as?

A

Abortion

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3
Q

What is the standardised abortion rate for women aged 15-44 in the UK?

A

16/1000 women

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4
Q

What % of abortions in the UK are carried out at under 13 weeks gestation?

A

92%

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5
Q

What % of abortions in the UK are carried out under 10 weeks?

A

80%

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6
Q

What % of abortions carried out in the UK were medical?

A

51%

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7
Q

What law governs abortions in England, Scotland, and Wales?

A

The 1967 Abortion Act

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8
Q

What is the age limit for abortion under the 1967 abortion act?

A

24 weeks

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9
Q

What are the requirements for abortion under the 1967 abortion act?

A

Can only be performed when;

  • Reduces risk to woman’s life
  • Reduces risk to her physical or mental health
  • Reduces risk to physical or mental health of her existing children
  • Baby is at substantial risk of being seriously mentally or physically handicapped
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10
Q

How is it confirmed that the criteria for abortion is met under the 1967 abortion act?

A

2 medical practitioners must certify in good faith by signing from HSA1 that at least 1 of these criteria apply

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11
Q

Under which of the criteria of the 1967 abortion act are most abortions performed?

A

Criteria 2 (risk to physical or mental health)

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12
Q

When is there no upper limit on gestation under the 1967 abortion act?

A
  • Risk to mother’s life
  • Risk of grave, permanent injury to mothers physical/mental health
  • Substantial risk that, if the child were born, it would have such physical or mental abnormalities as to be seriously handicapped
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13
Q

What are the usual scenarios for abortion after 20 weeks?

A
  • Following amniocentesis

- In very young girls who have concealed or not recognised the pregnancy

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14
Q

How does the abortion law differ in Northern Ireland?

A

Abortion is unlawful other than in restricted circumstances

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15
Q

What do the GMC guidelines state regarding girls under 16 requesting an abortion?

A

Girls under 16 may be able to make an informed decision without parental consent if they are deemed to have the capacity to do so

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16
Q

When do GMC guidelines state that abortions can be provided to girls under 16 without parental knowledge?

A
  • The girl understands all aspects of the advice and its implications
  • You cannot persuade her to tell her parents, or to allow you to tell them
  • It is in the best interests of the young person to receive the advice and treatment without parental knowledge and consent
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17
Q

Can the consent of a girl under 16 override parental refusal to allow abortion?

A

Yes, if they are competent

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18
Q

When can someone with parental responsibility consent for abortion on a girls behalf?

A

If they lack capacity

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19
Q

What should be done if someone is parental responsibility is consenting to abortion because the young person lacks capacity?

A

The views of the young person should be heard and taken into consideration

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20
Q

What should be considered in a person presenting for abortion when they are unable to consent?

A

Should consider possibility of sexual abuse - if young person does not have capacity to consent to abortion, do they have capacity to consent to sexual intercourse?

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21
Q

What is strongly advised regarding terminations in girls aged <16?

A

You should seek medico-legal advice if you have any uncertainty

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22
Q

What steps should be taken before termination of pregnancy?

A
  • Confirm patient is pregnant
  • Counsel her to help her reach the decision she will least regret
  • Most clinics provide optional counselling - encourage to utilise this if she would find it helpful
  • Discuss methods of abortion and choices available
  • Ask her to consider alternatives
  • Ask about her partner
  • Ideally, allow her time to consider her decision
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23
Q

What is the main alternative to abortion?

A

Adoption

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24
Q

Can the woman’s partner consent to, or refuse, TOP?

A

No

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25
Q

What should be considered when allowing a woman time to consider her decision to abort?

A

The earlier the termination is performed, the lower the risk of complications

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26
Q

What should be done if the patient decides on TOP?

A
  • Screen for chlamydia
  • Risk assessment for other STIs, and screen if indicated
  • Discuss further contraceptive needs
  • Check rhesus status
  • Assess risk of VTE
  • Establish if smear is due
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27
Q

What % of women attending abortion services screen positive for chlamydia?

A

10-13%

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28
Q

What % of women with chlamydia would get post-operative salpingitis if untreated?

A

25%

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29
Q

When can contraception be started after abortion?

A

Can start pill next day, or insert IUD at time

30
Q

Why is it important to check rhesus status before TOP?

A

If negative, she needs anti-D

31
Q

What should be done if smear is due in a patient presenting for TOP?

A

Can offer within abortion service, or give advice about when and where it can be done

32
Q

How long after the decision to proceed should a woman undergo abortion?

A

Within 5 days

33
Q

What is the maximum waiting time between initial referral for TOP to time of abortion?

A

3 weeks

34
Q

How can infection be prevented in abortion?

A

Antibiotic prophylaxis and/or infection screening

35
Q

Why is antibiotic prophylaxis recommended with TOP?

A

Because 10% of women will develop genital tract infection after abortion

36
Q

What is the antibiotic of choice for prophylaxis in abortion?

A

Metronidazole

37
Q

What are the options for surgical abortion?

A
  • Vacuum aspiration

- Dilation and evacuation

38
Q

What is given alongside surgical abortion in cases of less than 14 weeks gestation?

A

Vaginal or sublingual misoprostol 400mcg 3 hours before surgery

39
Q

When is vacuum aspiration a suitable management option for abortion?

A

Up to 14 weeks gestation

40
Q

What should be followed when vacuum aspiration is performed before 7 weeks gestation?

A

Strict protocols to ensure the gestational sac has been fully removed

41
Q

How is it ensured that the gestational sac has been fully removed when vacuum aspiration is performed before 7 weeks gestation?

A
  • Examination of aspirate

- Follow up blood tests for hCG

42
Q

What gestation is dilation and evacuation a suitable management option?

A

14-24 weeks gestation

43
Q

What is recommended for dilation and evacuation for TOP, in terms of the procedure?

A

Ultrasound guidance

44
Q

What are the options for anaesthesia for surgical abortions?

A
  • Local anaesthesia
  • General anaesthesia
  • Conscious sedation
45
Q

What analgesia should be offered for surgical abortions?

A

NSAID should be routinely offered

46
Q

How is medical abortion performed?

A

Regimens using 200mg oral mifepristone followed by misoprostol

47
Q

How is misoprostol administered in medical abortion?

A

Can be vaginal, buccal, or sublingual

48
Q

At what gestation is medical abortion a suitable management option?

A

Any gestation

49
Q

What should be performed before any medical abortion after 21+6?

A

Feticide

50
Q

What analgesia is recommended for medical abortions?

A

Analgesic such as NSAID, but stronger analgesia may be required in some cases

51
Q

Why is paracetamol not recommended for analgesia in medical abortion?

A

It is ineffective for this indication

52
Q

When should anti-D be given in TOP?

A

In all non-sensitised RhD-negative women

53
Q

What aftercare should be provided after abortion?

A
  • Discuss contraception, and supply if accepted
  • Provide list of possible symptoms, highlighting those that need urgent medical attention
  • If abortion confirmed at time of procedure, no need for follow up
  • Arrange further counselling for women who experience long-term distress
54
Q

When can intrauterine contraceptives be inserted immediately after an abortion?

A

When successful abortion has been confirmed

55
Q

Is TOP a safe procedure?

A

Yes, considered a safe procedure, and complications are rare

56
Q

What are the most common complications of TOP?

A
  • Infection
  • Cervical trauma
  • Failed TOP
57
Q

What % of terminations are complicated by infection?

A

Up to 10%

58
Q

How can the infection rate in TOP be reduced?

A

Prophylactic antibiotics or pre-procedure scanning for antibiotics

59
Q

What is the risk of cervical trauma from TOP?

A

1%, lower if performed early

60
Q

Is cervical trauma a risk in all types of TOP?

A

No, only a risk in surgical abortion

61
Q

What is the risk of failed TOP?

A

Less than 1%

62
Q

What are the uncommon complications of TOP?

A
  • Haemorrhage
  • Perforation of uterus
  • Psychological problems
63
Q

What is the risk of haemorrhage from TOP in the first trimester?

A

1 in 1000

64
Q

What is the risk of haemorrhage from TOP in the second trimester?

A

4 in 1000

65
Q

What is the risk of perforation of uterus in TOP?

A

1-4 in 1000

66
Q

Is perforation of the uterus a risk of all types of TOP?

A

No, surgical abortion only

67
Q

Do many women having an abortion experience long-term psychological sequlae?

A

No, only a small proportion

68
Q

What psychological effect is common with abortion?

A

Early distress

69
Q

Is termination of pregnancy more likely to be associated with poor mental health outcomes than if pregnancy is continued?

A

No

70
Q

What might have serious consequences on a woman’s mental health, or that of her families?

A

Denial of, or lack of, legal abortion services

A - MSRA Gynaecology [8] (52 decks)

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