2: Unplanned pregnancy and psychosocial problems Flashcards
How many abortions are carried out in the UK every year?
200,000
Failure of what is a common reason for abortion?
Failure of contraception
Apart from failure of contraception, what are some other reasons women choose to have an abortion?
Pregnancy as a result of abuse
Lack of knowledge about implications of pregnancy, family planning
If you become pregnant, what are your three options?
1. Continue with the pregnancy and keep the baby
2. Continue with the pregnancy and put the baby up for adoption
3. End the pregnancy via termination
The rates of abortion are highest in which age group?
20 - 24
Having an abortion is (safer / more dangerous) than carrying a baby to term.
safer
Abortion rates are strongly associated with which social factor?
Deprivation
Which legal act was written to regulate abortions?
Abortion Act (1967)
Under the Abortion Act, who has to approve an abortion before it occurs?
Two registered medical practioners
Under the Abortion Act, where do abortions have to take place?
NHS hospitals or NHS-approved centres
Under the Abortion Act 1967, which forms need to be filled out
a) by two medical practitioners for a planned abortion
b) by one medical practitioner for an emergency abortion?
a) Certificate A
b) Certificate B
In general, when is abortion acceptable?
When risks (physical / mental) of carrying baby to term are greater than the benefits for mother or existing children
When baby would be born with severe physical or mental abnormalities
After which week in gestation can an abortion NOT be performed?
Week 24
When is an emergency abortion acceptable?
When abortion is necessary to save the life of, or prevent serious physical / mental harm to, the pregnant women
Can abortions be performed for under 16s?
Yes - if they are assessed to be competent
As a doctor, which term is used to describe opting out of any procedures related to abortion?
Conscientious objection
If you conscientiously object to carrying out procedures related to abortion or giving advice to patients, what must you do?
Hand patient over to a qualified medical practitioner who can look after them instead
Treatment in the event of an ____ may not be denied on the grounds of conscientious objection.
emergency
How long after being referred will patients expect to be seen in a termination of pregnancy clinic?
2 weeks
What happens at the first appointment in the TOP clinic?
Discussion of abortion and certainty to proceed
Ultrasound abdomen to make sure pregnancy is uterine i.e not ectopic
Full medical history
Discussion of abortion methods
While an abortion is being arranged, patients may be screened for which diseases?
STIs
Which drugs may patients be given in the time between their initial consultation and termination of pregnancy?
Contraception
Prophylactic antibiotics
In terms of gestational age, when is the cutoff for abortion?
24 weeks
The legal cutoff for abortion is 24 weeks.
What does this mean practically?
Abortion needs to be carried out by 23 weeks 6 days
The legal cutoff for abortion is 24 weeks.
What is the exception to this law?
Foetal abnormalities
If present, abortion is legal at any gestational age
The legal cutoff for abortion is 24 weeks.
When is the NHS Tayside cutoff?
19 weeks (medical abortion)
12 weeks (surgical abortion)
Which drugs are used in medical termination of pregnancy?
1. Mifepristone - anti-progesterone which causes the endometrium to become unviable for pregnancy
2. Then misoprostol 1-2 days later - prostaglandin which causes uterine contractions, expelling the pregnancy
Misoprostol is given every ___ hours until abortion occurs.
three hours
If a medical abortion fails, what may have to be carried out?
Surgical abortion
Surgical abortion may be carried out up to which point in gestation?
12 weeks
Or in an emergency e.g following failed medical abortion
What are two methods of surgical abortion?
Vacuum aspiration
Dilatation and evacuation
How may the cervix be primed for surgical abortion?
Misoprostol
Prostaglandin analogue, encourages uterine contractions > expellation of products
What form of contraception may be fitted during surgical abortion?
Long-acting reversible contraception
e.g intrauterine implant, system (hormones) or device (copper)
What complications can be caused by both medical and surgical abortion?
Pain
Haemorrhage
Infection
Incomplete abortion
Uterine rupture
What is a rare complication of medical and surgical abortion which is a medical emergency?
Uterine rupture
What test are women given post-abortion?
Urine pregnancy test
Which drug are women given post-abortion?
Anti-D injections
To prevent Rhesus disease in subsequent pregnancies (if mum is Rhesus-negative and foetus was Rhesus-positive)
Women MUST be encouraged to use ___ post-abortion.
Contraception
What are psychosexual problems?
Disturbance of sexual functioning
Which may be caused by non-organic problems (psychological, emotional)
What are the most common psychosexual problems for men?
Loss of libido
Premature ejaculation
Performance anxiety
What are the most common psychosexual problems for women?
Anorgasmia
Vaginismus
Loss of libido
