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Obs & Gynae > Abortion > Flashcards

Abortion Flashcards

1
Q

Definition of abortion

A

Termination of pregnancy by removal or expulsion of a fetus or embryo from the uterus
Prior to viability

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2
Q

What is the gestational week cutoff for NHS abortion

A

12 weeks

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3
Q

What is the gestational limit of abortion law and the exception

A

24 weeks

Unless fetal abnormality

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4
Q

What is the sexual offences act 2003

A

Girls aged 13 and under cannot consent to contraception or abortion.

Must involve social services and/or police

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5
Q

What is Gillick competency

A

Can assess individuals capacity to consent for abortion and contraception ages 14-16

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6
Q

What is the Frasier guideline

A

Guidelines for consenting minors for contraception only, NOT ABORTION

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7
Q

Preferred abortion procedure for <7 weeks

A

Early medical abortion (EMA) under ultrasound - before, during and after

Can be offered up to 9 weeks but surgical may be better.

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8
Q

Preferred abortion procedure for 7+ weeks

A

Surgical termination:

  • manual vacuum aspiration <14 weeks
  • dilation and evacuation 14-24 weeks
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9
Q

What can be done prior to surgical termination and who is it routinely offered to

A

Prostaglandin for cervical prep

For:
Age <18
>10 weeks pregnant
Nulliparous women

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10
Q

What is the medical abortion regimen

A

Day 1: mifepristone 200mg oral. Swallowing must be directly observed in hospital.
Day 2/3: misoprostol up to 5 doses at 3 hourly intervals depending on gestation
Day 14: follow up

Interact with NSAIDs so paracetamol for pain

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11
Q

Contraindications for medical abortion (9)

A 
>9 weeks gestation
Suspected ectopic
Chronic renal disease - mifepristone acts like aldosterone
Hepatic failure - bleeding risk 
CV disease
Long term corticosteroids
Allergy
Anticoagulation 
Bleeding disorder
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12
Q

Complications of abortion in descending order of risk

A 
Sepsis
Failure - medical > surgical
Haemorrhage 
Uterine perforation
Cervical tear
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13
Q

What increases risk of haemorrhage in abortion

A

Increasing gestation weeks

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14
Q

What increases risk of cervical tears with abortion

A

Younger than 18

Higher parity

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15
Q

What recommendations are in place to reduce complications

A

Blood test for Hb, ABO group and Rhesus group

Referral within 5 days

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16
Q

Aftercare for abortion

A 
No sex or tampons for 2 weeks
14 day follow up
Anti D if rhesus negative
Antibiotics for high risk (swabs may not identify all bacteria)
Discuss contraception
17
Q

What is mifepristone

A

Progesterone receptor blocker

Causes shedding of uterine endometrium

18
Q

What is misopristol

A

Prostaglandin analogue given as a pessary

Causes dilation of cervix

19
Q

Method of feticide after 24 weeks

A

KCl injection into fetal heart

Followed by removal of POC (stimulate labour with misoprostol or surgical)

Obs & Gynae (37 decks)

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