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YEAR 3 REPRO > abortion/ethics revision > Flashcards

abortion/ethics revision Flashcards

1
Q

what form is abortion certified on

A

HSA1

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2
Q

how many doctors are needed to sign an HSA1 form

A

2

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3
Q

how many clauses are there for an HSA1 form

A

5

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4
Q

most abortions in the UK come under which clause

A

C (98%)

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5
Q

what is clause A on the HSA1 form

A

risk of life of the pregnant woman

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6
Q

what is clause B on the HSA1 form

A

prevent permanent injury to the physical or mental health of the pregnant woman

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7
Q

what is clause C on the HSA1 form

A

the pregnancy has not exceeded 24 weeks

risk of injury to the physical or mental health of the pregnant woman

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8
Q

what is clause D on the HSA1 form

A

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

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9
Q

what is clause E on the HSA1 form

A

substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped

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10
Q

what are the 2 criteria for an emergency abortion (HSA2 form)

A

save life of pregnant woman

prevent grave permanent injury to physical or mental health of pregnant woman

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11
Q

when should an HSA2 form be filled out

A

before procedure but if not possible then within 24 hours

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12
Q

when should an HSA4 form be sent to the CMO

A

within 7 days

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13
Q

what is the law that outlines abortion ruling

A

Abortion act 1967

amended by the HFEA 1990

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14
Q

what is the next most common reason for abortion after clause C

A

clause E

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15
Q

what is the gestational limit of clause E

A

no gestational limit

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16
Q

does conscientious objection apply to all situations

A

no - not in emergencies or indirect tasks

and should not delay or prevent a patients access to care

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17
Q

if you are a CI you can object to referred the patient to another doctor
true/false

A

false

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18
Q

what are the 2 methods of abortion

A

medical and surgical

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19
Q

how is the type of abortion determined

A

patient choice
gestation
regional availability

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20
Q

how is a clinical estimation of gestation made

A 
LMP +/- date of UPT
palpable uterus (12 weeks)
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21
Q

what scan is used to assess gestation

A

ultrasound

abdominal or transvaginal (<6 weeks)

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22
Q

what are the 2 medications used in a medical abortion

A

mifepristone

misoprostol

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23
Q

what is the dose of mifepristone in a medical abortion

A

200mg

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24
Q

what is the dose of misoprostol in a medical abortion

A

800mcg

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25
Q

outline a medical abortion

A

mifepristone then 24-48hrs later misoprostol

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26
Q

how is mifepristone taken

A

PO

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27
Q

how is misoprostol taken

A

PV / SL

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28
Q

what gestation must someone be to have an EMAH

A

< 10 weeks

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29
Q

if a woman is > 10 weeks gestation, what may be required after the first dose of misoprostol

A 
repeated doses
800mcg (initial dose) 
then 400mcg (3 hourly) (up to 4)
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30
Q

after what gestation do women need to travel to england for a medical abortion

A

after 19+6, > 20 requires travel to england

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31
Q

true/false

medical abortion can only be given up to 24 weeks

A

false

can be given any stage of gestation

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32
Q

what is the action of mifepristone

A

antiprogestogenic steroid - sensitises the myometrium to prostaglandin-induced contractions and ripens the cervix

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33
Q

what is the action of misoprostol

A

synthetic prostaglandin analogue

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34
Q

EMAH is not recommended for people under the age of

A

16

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35
Q

what should be considered when considering EMAH

A

medical/social suitability e.g. support at home, distance from hospital

36
Q

outline surgical abortion

A

removal of products of conception via surgical procedure under anaesthetic
cervical priming via misoprostol or osmotic dilators

37
Q

how is a surgical abortion carried out under 14 weeks

A

electric vacuum aspiration (GA)

manual vacuum aspiration (up to 10 weeks, LA)

38
Q

how is surgical abortion carried out over 14 weeks

A

dilatation and evacuation

39
Q

after how many weeks do you need to travel to england for surgical abortion

A

14

40
Q

complications of abortion tend to _____ with increasing gestation

A

increase

41
Q

abortions are risky and unsafe

true/false

A

false

rates of complications are very low

42
Q

give 2 complications of surgical abortion only

A

uterine perforation

cervical trauma

43
Q

what are 3 complications that can occur with either

A

infection
failed/incomplete abortion
haemorrhage +/- blood transfusion

44
Q

who should get antibiotic prophylaxis before an abortion

A

STOP

MTOP with increased risk of STI (if screening not available/preformed)

45
Q

what is the recommended regimen for antibiotic prophylaxis

A

7 days 100mg doxycycline BD
or
1g oral azithromycin + 500mg daily for 2 days

46
Q

who should rhesus iso-immunisation be offered to

A

rhesus D negative blood group

47
Q

why are Rh - women offered rhesus iso-immunisation

A

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

48
Q

what is rhesus iso-immunisation

A

administration of Anti-D Ig to at risk Rhesus negative women

49
Q

if woman is at a high risk or very high risk of VTE what should they be offered

A

high risk - LMWH for 1 week after abortion

very high risk - LMWH before abortion and continuing longer

50
Q

how many women in the UK have repeat abortion

A

1/3

51
Q

you are infertile after abortion

true/false

A

false

> 90% ovulate within 1 month (as early as 8 days after medical)

52
Q

what should be initiated at time of abortion

A

contraception for future

53
Q

when can most contraceptive methods be started after abortion

A

straight away

54
Q

contraception is immediately affective if started

A

day of abortion or within 5 days

55
Q

when should intrauterine methods be avoided

A

in presence of post-abortion sepsis

56
Q

if the POP is started after 5 days post abortion how long should a condom be used

A

2

57
Q

if CHC/DMPA/SDI/ is started after 5 days post abortion how long should a condom be used

A

7 days

58
Q

when can an IUS/IUD be fitted after surgical abortion

A

when expulsion of pregnancy is confirmed

59
Q

when can hormonal contraceptive methods be started after abortion

A

any time after surgical or medical including day of

60
Q

what barrier method cant be used after 2nd TOP

A

diaphragm

61
Q

is a review required after an abortion

A

no - except EMAH

62
Q

what is the follow up of an EMAH

A

low sensitivity UPT performed at least 2 weeks after abortion

63
Q

under what 3 conditions can you treat an adult without consent

A

emergency
AWIA
MHA

64
Q

what law would you be breaching if you touched someone without their consent even if they came to no harm

A

battery

65
Q

what law would you be breaching if you left out relevant information

A

negligence

66
Q

can consent be withdrawn

A

yes

67
Q

is consent binding

A

no

68
Q

is a signature proof of consent

A

no

69
Q

is a contract binding

A

yes

70
Q

can a patient demand treatment

A

no

71
Q

if a competent adult rejects treatment for illogical reasons is this ok

A

yes as long as they are deemed to have capacity

72
Q

in order to have capacity what 3 criteria must be met

A

understand the treatment options and weigh up potential benefits and risks
retain the information
decide and communicate decision

73
Q

at what age are you presumed to have capacity to consent and according to what law

A

16 and over unless evidence to contrary

Age of Legal Capacity (Scotland) Act 1991

74
Q

do parents/legal guardian have to be consulted about childs treatment

A

yes

75
Q

can the state overrule parents

A

yes if it is in best interest of child - assessed by judge

76
Q

what law protects the treatment of children and young people

A

Children and Young People Act (Scotland) 2014

77
Q

can someone under 16 have capacity to consent

A

yes - gillic competence

78
Q

who has parental responsibility of a child if parents are divorced

A

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

79
Q

when is PR lost

A

giving child up for adoption

80
Q

when are 2 times a doctor can disclose patients info

A

if patent consents

if required by law in public interest

81
Q

when is it required by law in public interest to disclose info

A

certain infectious diseases

risk of death or serious harm or crime (murder not theivery)

82
Q

can info be disclosed upon request of police

A

no - needs to be a court order or act of parliament

83
Q

can you disclose info if patients employer, school, lawyer, insurance company asks

A

no

84
Q

is capacity decision specific

A

yes

85
Q

what should you do if a patient is not fit to drive

A

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

86
Q

if a person below the age of 16 is deemed to have capacity do their parents have a right to be told information

A

not without consent of child

YEAR 3 REPRO (11 decks)

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