Abortion Flashcards
What is law NI?
Decrim.
Abortion on request up to 12 weeks one signature. No conditions necessary. Doctors nurses and midwives.
24 weeks similar to clause C still 1 sig
Can CSRH trainees opt out abortion?
Yes same as everyone as permitted by law (but must participate in all forms of care except that specified)
When does RCOG say feticide necessary?
After 21+6
Before this it is very rare that a child would be born alive. Note 11% born alive 20-22 weeks but 0.1% 20-22 weeks survive to d/c but this was 1995
Feticide is important as live birth contradicts the intention of abortion.
A live birth will result in care in the child best interest.
(check this is consistent with other sources)
How is feticide achieved?
KCl 2-3ml 15% into ventricle repeated if not asystolic in 30-60s
2min asystole document
Scan 30-60min to confirm
Can also use intramniotic or thoracic digoxin or inject lignocaine but failures seen with these methods
If twins need to surgically occlude vascular system of twin concerned
What are risks of mtop? (First trim)
Infection <1:100
Ongoing preg 1:100
Need for further intervention 7:100
Severe bleeding <1:1000
What are risks of STOP? First trim
Further procedure 3.5/100
Infection <1:100
Severe bleeding <1:1000
Perforation 1:1000
Ongoing pre 1:1000 (higher <7/40)
CI to MTOP?
Ectopic
Allergy
Severe uncontrolled asthma
Chronic adrenal failure
Porphyria
Last 3 could use miso alone if needed
Who needs prophylactic abx?
Stop only: eg doxy 100mg bd 3/7 within 2 hrs procedure
Optimal regimen not known
Nitroumidazoles/tetracyclines/penicillins
Why give mife and miso?
200 mife 800 miso (400 if not passed 4 hours=1st trim)
More effective
Shorter induction to abortion interval
Reduced SE
Decreased rate ongoing preg
If miso alone 800 plus 400 3 hourly until passed first trim
12-24 weeks most effective regimen mtop?
Mife 200 miso 800
3 hourly miso until passed
If miso alone same as above (which is same as first trim)
Miso over 24/40?
Lower doses
Longer intervals
Risk scar rupture/uterine rupture
Pain management?
NSAIDs
Heat
If needed narcotics/epidural
Stop prior to 14/40 how do you do it?
MVA (size 4-12 cannula ls) or EVA
No lower limit
No sharp curette
STOP 14/40-24/40 how do you do it?
D+E (NOT D&C sharp)
Cervical prep
Long forceps
Vacuum aspiration up to 15-16 weeks with large bore tubes/cannulas
What cervical prep do you do STOP?
< 12 ONE of…
-mife 200 24-48 hours prior
-miso 400 s/l 1-2hrs prior
-miso 400 pv/buccal 2-3hrs prior
12-19 weeks
Combiné mife and miso using doses above
Or combine either or both with eg dilapan
19-24
Dilapan plus one or both of mife/miso
Is GA STOP recommended?
Not routinely
More complications/longer stay
Ideally conscious sedation with cervical block
Or LA with analgesics verbal reassurance
What to advise re post abortion?
Bleeding >2 maxi pads an hour > 2 hr
Offensive d/c
Fever after 24hr
Worsening pain especially if PUL
Minimal bleeding or still feel preg 1/52
What PT and when?
High sensitivity 4/52
Low sensitivity 2/52
How to manage incomplete?
Surgical or medical (no infection)
If fetus give mife first then miso
Just miso if no fetus
If infection urgent evac and immed abx if sepsis broad spec iv eg ampicillin metro gent
Contraception post abortion when can HC be started post MTOP?
Immed After mife.
Except vaginal ring/iud-which can be inserted once pregnancy expelled
Depo at time mife might slightly reduce abortion effectiveness so tell pt.
Telephone abortion-who needs a scan?
History of ectopic or PID
Tubal surgery
Abdominal pain
IUD in situ
Unscheduled bleeding
If cannot confirm pregnancy duration by asking
LMP
Hormones
Timing UPSI
BF
Negative PT timing
How must all babies still born after 24 weeks (including late TOP) be managed?
Registered at stillborn
Buried or cremated
How must all fetus any gestational age born signs life and then dies be managed?
Birth registered
Buried and cremated
What options for pregnancy remains regardless of any fetal tissue present?
Sensitive incineration (sep to clinical waste)
Cremation
Burial
Anti D who gets it?
All top over 10 weeks
All STOP ‘consider’
Who gets abx?
All STOP
Do not routinely offer mtop
