Abortive care

Question 1

Do women have a legal right to abortion in mainland uk?

Answer 1

no

Question 2

How can the 1967 abortion act be certified to allow for an abortion to take place?

Answer 2

be certified by TWO doctors

Question 3

Is there a time limit for a foetus with a serious disability?

Answer 3

no…

Question 4

What are the five criteria for abortion? (A-E)?

Answer 4

A-risk of life to pregnant woman greater than if pregnancy were terminated

B- abortion necessary to prevent grave injury to physical or mental health of pregnant woman

C- not exceeded 24 weeks and continuation would risk mental and physical health

D- affecting existing children of the pregnant woman

E- physical or mental abnormalities -> handicapped

Question 5

Does a foetus have a legal right to life?

Answer 5

no…regardless of gestation?!

Question 6

Which medical procedures does the chief medical officer need to know about?

Answer 6

abortion

- marital status, smoking, ethnicity

Question 7

How many women will have had an abortion by the time they reach 45?

Answer 7

1/3

Question 8

Medical abortions can be provided up to how many weeks?

Answer 8

20 weeks

Question 9

Up until when can surgical procedures be performed in Scotland?

Answer 9

13 weeks

Question 10

What are the two types of abortion?

Answer 10

medical or surgical

Question 11

What is the best time to perform an abortion?

Answer 11

9 weeks since last period

Question 12

Can abortions under 16 year be performed at home?

Answer 12

always in hospital

Question 13

When can inpatient medical abortion take place?

Answer 13

> 12 weeks

if no support

Question 14

List three criteria for patients who must be seen in person

Answer 14

Hx of pain and bleeding
IUD in situ
significant medical problems
high risk of ectopic pregnancy

Question 15

What is the drug regimen for medical abortion?

Answer 15

Mifepristone

Misoprostol

Question 16

What is the MOA of mifepristone?

Answer 16

anti-progesterone

Question 17

How is mifepristone taken?

Answer 17

200 mg OD

Question 18

When and how is misoprostol taken?

Answer 18

800 mcg vaginal/buccal/sublingual

taken on day 3

Question 19

Aside from misoprostol and mifepristone, what else forms part of the abortion package?

Answer 19

ibuprofen
cocodamol
pregnancy test
sanitary pads
prochlorperazine
OCP
doxycyline

Question 20

What are the symptoms of medical abortion?

Answer 20

vaginal bleeding

lower abdo pain

Question 21

After how long will abortion symptoms take place after misoprostol?

Answer 21

2-3 hours

Question 22

What is the benefit of surgical over medical?

Answer 22

minimal abdo pain
minimal vaginal bleeding
coil can be fitted (IUC)
smear can be done

Question 23

After how long following an abortion are you fertile again?

Answer 23

after 5 days following abortion

Question 24

What is the surgical procedure for abortion?

Answer 24

suction device

Question 25

Three contraindications for medical abortion?

Answer 25

``` long term corticosteroids hypertension adrenal insufficiency sickle cell high cholesterol ```

Question 26

List two contraindications for surgical abortion

Answer 26

BMI 40 BMI 35 with comodrbidities Anaesthetic complications Difficulty of accessbility e.g. cervical tumour

Question 27

List three complications of abortion

Answer 27

``` failure to end pregnancy retained non viable tissue infection haemorrhage cervical tear uterine perforation pscyhological impact ```

Question 28

When should you seek medical attention following an abortion?

Answer 28

very heavy bleeding symptoms of anaemia: dizziness, SoB, palpitations Offensive vaginal discharge High fever and systemically unwell

Question 29

Which questions should you ask presenting to A&E with vaginal bleeding who had an abortion three weeks ago?

Answer 29

``` type of abortion and process STI screen Did they take prophylactic antibiotics? Pain, fever, offensive discharge Contraception? Bleeding- how heavy? clots? pads? how many days? variability? ```

Question 30

Differential diagnosis for vaginal bleeding post abortion?

Answer 30

incomplete abortion endometritis uterine perforation (if surgical) side-effect of contraception

Question 31

What is RPOC?

Answer 31

retained products of conception

Question 32

Would RPOC have a positive or negative pregnancy test?

Answer 32

positive

Question 33

What is the management of RPOC?

Answer 33

Watchful waiting further misoprostol surgical

Question 34

How is RPOC diagnosed?

Answer 34

clinical + USS

Question 35

What are the signs and symptoms of endometritis?

Answer 35

``` persistent lower abdo pain pain with intercouse persistent bleeding offensive vaginal discharge fever ```

Question 36

What is the management of endometritis?

Answer 36

broad spectrum abx analgesia If sepsis- admit, IV abx, IV fluids

Question 37

What is a conscientious objection?

Answer 37

doctor who for religious/political/philosophical views disagree with abortion. Important to not express this but to say that you do not offer this procedure but that you are happy to refer onto a colleague

Question 38

What year is the most recent abortion act?

Answer 38

Abortion act 1967