abortion/ethics revision Flashcards
what form is abortion certified on
HSA1
how many doctors are needed to sign an HSA1 form
2
how many clauses are there for an HSA1 form
5
most abortions in the UK come under which clause
C (98%)
what is clause A on the HSA1 form
risk of life of the pregnant woman
what is clause B on the HSA1 form
prevent permanent injury to the physical or mental health of the pregnant woman
what is clause C on the HSA1 form
the pregnancy has not exceeded 24 weeks
risk of injury to the physical or mental health of the pregnant woman
what is clause D on the HSA1 form
pregnancy has not exceeded 24 weeks
risk of injury to the physical or mental health of any existing children of the family of the pregnant woman
what is clause E on the HSA1 form
substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped
what are the 2 criteria for an emergency abortion (HSA2 form)
save life of pregnant woman
prevent grave permanent injury to physical or mental health of pregnant woman
when should an HSA2 form be filled out
before procedure but if not possible then within 24 hours
when should an HSA4 form be sent to the CMO
within 7 days
what is the law that outlines abortion ruling
Abortion act 1967
amended by the HFEA 1990
what is the next most common reason for abortion after clause C
clause E
what is the gestational limit of clause E
no gestational limit
does conscientious objection apply to all situations
no - not in emergencies or indirect tasks
and should not delay or prevent a patients access to care
if you are a CI you can object to referred the patient to another doctor
true/false
false
what are the 2 methods of abortion
medical and surgical
how is the type of abortion determined
patient choice
gestation
regional availability
how is a clinical estimation of gestation made
LMP +/- date of UPT palpable uterus (12 weeks)
what scan is used to assess gestation
ultrasound
abdominal or transvaginal (<6 weeks)
what are the 2 medications used in a medical abortion
mifepristone
misoprostol
what is the dose of mifepristone in a medical abortion
200mg
what is the dose of misoprostol in a medical abortion
800mcg
outline a medical abortion
mifepristone then 24-48hrs later misoprostol
how is mifepristone taken
PO
how is misoprostol taken
PV / SL
what gestation must someone be to have an EMAH
< 10 weeks
if a woman is > 10 weeks gestation, what may be required after the first dose of misoprostol
repeated doses 800mcg (initial dose) then 400mcg (3 hourly) (up to 4)
after what gestation do women need to travel to england for a medical abortion
after 19+6, > 20 requires travel to england
true/false
medical abortion can only be given up to 24 weeks
false
can be given any stage of gestation
what is the action of mifepristone
antiprogestogenic steroid - sensitises the myometrium to prostaglandin-induced contractions and ripens the cervix
what is the action of misoprostol
synthetic prostaglandin analogue
EMAH is not recommended for people under the age of
16
what should be considered when considering EMAH
medical/social suitability e.g. support at home, distance from hospital
outline surgical abortion
removal of products of conception via surgical procedure under anaesthetic
cervical priming via misoprostol or osmotic dilators
how is a surgical abortion carried out under 14 weeks
electric vacuum aspiration (GA)
manual vacuum aspiration (up to 10 weeks, LA)
how is surgical abortion carried out over 14 weeks
dilatation and evacuation
after how many weeks do you need to travel to england for surgical abortion
14
complications of abortion tend to _____ with increasing gestation
increase
abortions are risky and unsafe
true/false
false
rates of complications are very low
give 2 complications of surgical abortion only
uterine perforation
cervical trauma
what are 3 complications that can occur with either
infection
failed/incomplete abortion
haemorrhage +/- blood transfusion
who should get antibiotic prophylaxis before an abortion
STOP
MTOP with increased risk of STI (if screening not available/preformed)
what is the recommended regimen for antibiotic prophylaxis
7 days 100mg doxycycline BD
or
1g oral azithromycin + 500mg daily for 2 days
who should rhesus iso-immunisation be offered to
rhesus D negative blood group
why are Rh - women offered rhesus iso-immunisation
abortion may be a sensitising event - foetal blood cells can gain access to maternal circulation - leads to development of anti-D antibodies which can cross the placenta in future pregnancies and destroy Rh +ve fetal blood cells
what is rhesus iso-immunisation
administration of Anti-D Ig to at risk Rhesus negative women
if woman is at a high risk or very high risk of VTE what should they be offered
high risk - LMWH for 1 week after abortion
very high risk - LMWH before abortion and continuing longer
how many women in the UK have repeat abortion
1/3
you are infertile after abortion
true/false
false
> 90% ovulate within 1 month (as early as 8 days after medical)
what should be initiated at time of abortion
contraception for future
when can most contraceptive methods be started after abortion
straight away
contraception is immediately affective if started
day of abortion or within 5 days
when should intrauterine methods be avoided
in presence of post-abortion sepsis
if the POP is started after 5 days post abortion how long should a condom be used
2
if CHC/DMPA/SDI/ is started after 5 days post abortion how long should a condom be used
7 days
when can an IUS/IUD be fitted after surgical abortion
when expulsion of pregnancy is confirmed
when can hormonal contraceptive methods be started after abortion
any time after surgical or medical including day of
what barrier method cant be used after 2nd TOP
diaphragm
is a review required after an abortion
no - except EMAH
what is the follow up of an EMAH
low sensitivity UPT performed at least 2 weeks after abortion
under what 3 conditions can you treat an adult without consent
emergency
AWIA
MHA
what law would you be breaching if you touched someone without their consent even if they came to no harm
battery
what law would you be breaching if you left out relevant information
negligence
can consent be withdrawn
yes
is consent binding
no
is a signature proof of consent
no
is a contract binding
yes
can a patient demand treatment
no
if a competent adult rejects treatment for illogical reasons is this ok
yes as long as they are deemed to have capacity
in order to have capacity what 3 criteria must be met
understand the treatment options and weigh up potential benefits and risks
retain the information
decide and communicate decision
at what age are you presumed to have capacity to consent and according to what law
16 and over unless evidence to contrary
Age of Legal Capacity (Scotland) Act 1991
do parents/legal guardian have to be consulted about childs treatment
yes
can the state overrule parents
yes if it is in best interest of child - assessed by judge
what law protects the treatment of children and young people
Children and Young People Act (Scotland) 2014
can someone under 16 have capacity to consent
yes - gillic competence
who has parental responsibility of a child if parents are divorced
births before 4 may 2006 - father only has PR if married to mother
births after 4 may 2006 - both parents have PR if named on birth certificate if divorced
when is PR lost
giving child up for adoption
when are 2 times a doctor can disclose patients info
if patent consents
if required by law in public interest
when is it required by law in public interest to disclose info
certain infectious diseases
risk of death or serious harm or crime (murder not theivery)
can info be disclosed upon request of police
no - needs to be a court order or act of parliament
can you disclose info if patients employer, school, lawyer, insurance company asks
no
is capacity decision specific
yes
what should you do if a patient is not fit to drive
inform them of legal duty to inform DVLA
if they continue to drive you should make every reasonable effort to persuade them to stop driving
if you discover they are driving against your advice contact DVLA
inform patient immediately as well as in writing once you have done so
if a person below the age of 16 is deemed to have capacity do their parents have a right to be told information
not without consent of child
