Abortion Care Flashcards
Which act gives doctors legal defense when preforming terminations?
1967 abortion act
When are patients able to have an abortion at home?
Under 12 weeks in Scotland.
Under 10 weeks in England and Wales
What act limits the time available for abortions?
The human fertilization and Embryology act 1990. Means patients can only have an abortion below 24 weeks gestation.
What is the 1967 abortion act?
Makes an abortion legal if preformed by registered medical practitioner. Must be authorized by two doctors.
What did the HFE Act 1990 do?
Remove time limit on abortions on a fetus with serious disability.
There is no set criteria for disability
Important history questions to ask regarding abortions and periods
When was your last menstrual periods?
Was it a normal period (heavy and as long as normal)?
Are your cycles regular?
What re the indications for an ultrasound before a termination?
IUD in situ,
LMP over 10 weeks,
Uncertainty around LMP,
Irregular/absent periods,
Ectopic pregnancy risk
Describe features of induced abortions
Medical abortions:
- Medical termination of pregnancy (MTOP)
- Early medical abortion at Home (EMAH)
Surgical abortions:
- Surgical termination of pregnancy (STOP).
- Manual vacuum aspiration (MVA),
- Electric vacuum aspiration (EVA)
- Dilation and Evacuation (D&E)
Describe features of spontaneous abortion
Usually referred to as a miscarriage and occurs before 24 weeks.
Who should get screening for ectopic pregnancy?
Previous ectopic pregnancy,
Damaged fallopian tubes
IUD in place
What are the symptoms of an ectopic pregnancy?
Non ruptures - Vaginal bleeding/spotting and abdominal pain.
Ruptured - Pain under ribs/shoulder tip pain, severe abdominal pain, signs of shock and rebound tenderness.
WHat are the CI to medical abortion?
Allergy to mifepristone or misoprostol,
Chronic adrenal failure,
Severe uncontrolled asthma,
Inherited porphyria,
Known/suspected ectopic pregnancy.
What are the CI to surgical abortions?
Inability to remove pregnancy through cervix.
What are the examinations and investigations done prior to an abortion?
Examination - if surgical abortion then do BP, pulse, respirations, temp and BMI
Screen for STIs,
Rhesus status for abortions > 10-12 wks.
Hb if concerned for anaemia.
Selective other tests eg LFTs, UEs
Explain the pharmacology of the drugs used in terminations
MiFepristone (F for first) - Antiprogesterone drug which causes decidual necrosis, detachment, cervical softening and dilation. Sensitization to prostaglandins.
MiSoprostol (S for second) - Prostaglandin-analogue. Softens and dilates the cervix. Causes uterine contractions and expulsion of the pregnancy.
What is the regimens for medical abortions under 12 weeks?
MiFepristone 200mg taken orally.
Then 24-48 hours later
MiSoprostol 800 micrograms (four tables) taken vaginal, buccal or sublingual. Ideally vaginal!
Patients are also given cyclizine and dihydrocodine.
How long does it take for a pregnancy test to turn negative after termination?
6 weeks for shop bought tests.
3 weeks for sandyford tests.
What are the side effects of misoprostrol?
Hot flushes,
Dizziness,
Chills,
N+V,
Headaches
Diarrhoea.
Fewer GI side effects if taken vaginally.
What should patients expect following a medical abortion?
Abdominal cramping (more painful than a periods)
Vaginal bleeding (heavier than period and does have clots)
When should patients seek medical attention following termination?
Very heavy bleeding (soaking >2pads per hour),
Little or no bleeding 24 hours after misoprostrol.
Ongoing/new abdominal pain.
Fever and or unusual smelling or discoloured vaginal discharge.
Feeling generally unwell.
Ongoing bleeding after 4 weeks.
What is the difference for medical abortions done >12 weeks?
Extra misoprostol 400 mcg is given every 3 hours until abortion occurs.
Feticide recommended from 22 weeks onwards to avoid possibility of a live birth (digoxin or potassium chloride)
Describe features of vacuum adpiration
Done up to 13 weeks.
Misoprostrol is used to cause cervical dilations.
Local or general anesthesia.
Aspiration of pregnancy with electrical or manual suction.De
Describe features of dilation and evacuation
It is done after 13 weeks.
Generally done under GA.
Cervical preperation then removal of pregnancy using forceps and vaccum aspiration
What are the side effects following surgical abortion?
Abdominal cramping and vaginal bleeding. Avoid bathing, swimming, sex and tampons.
When should you seek medical attention following surgical abortion?
Very heavy bleeding,
High fever or systemically unwell,
Persistent or worsening abdominal pain,
Unusual-smelling vaginal discharge,
Signs of ongoing pregnancy
What are the complications of abortions?
Failure to end pregnancy,
Retained tissues,
Infections,
Haemorrhage,
Cervical tear,
Uterine perforation.
Describe features of retained products of conception
Placental or fetal tissue left inside the uterus. This usually presents with persistent pain and or bleeding.
May have infection.
Usually clinical diagnosis but can do ultrasound
How can you manage retained products of pregnancy?
Watchful waiting,
Medical - further dose of misoprostol.
Surgical - evacuation of retained products of conception.
Urgent evacuation if heavy bleeding/haemodynamically unstable/infection
Describe features of endometritis
It is an infection of the lining of uterus which may extend to upper genital tract.
Presentation: lower abdominal pain/tenderness, pain with intercourse, persistent bleeding, offensive vaginal discharge, fever and cervical motion tenderness.
May occur in first few days after abortion
How do you manage endometritis?
Give broad spectrum antibiotics and analgesia.
Admission to hospital for IV abx and fluids if systemically unwell.
Describe features of uterine perforation
Usually recognized at time of procedure or presents 48hr later with severe pain +/- bleeding.
Do laparoscopy/laparotomy and repair.
