Abortive care Flashcards
Do women have a legal right to abortion in mainland uk?
no
How can the 1967 abortion act be certified to allow for an abortion to take place?
be certified by TWO doctors
Is there a time limit for a foetus with a serious disability?
no…
What are the five criteria for abortion? (A-E)?
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
Does a foetus have a legal right to life?
no…regardless of gestation?!
Which medical procedures does the chief medical officer need to know about?
abortion
- marital status, smoking, ethnicity
How many women will have had an abortion by the time they reach 45?
1/3
Medical abortions can be provided up to how many weeks?
20 weeks
Up until when can surgical procedures be performed in Scotland?
13 weeks
What are the two types of abortion?
medical or surgical
What is the best time to perform an abortion?
9 weeks since last period
Can abortions under 16 year be performed at home?
always in hospital
When can inpatient medical abortion take place?
> 12 weeks
if no support
List three criteria for patients who must be seen in person
Hx of pain and bleeding
IUD in situ
significant medical problems
high risk of ectopic pregnancy
What is the drug regimen for medical abortion?
Mifepristone
Misoprostol
What is the MOA of mifepristone?
anti-progesterone
How is mifepristone taken?
200 mg OD
When and how is misoprostol taken?
800 mcg vaginal/buccal/sublingual
taken on day 3
Aside from misoprostol and mifepristone, what else forms part of the abortion package?
ibuprofen cocodamol pregnancy test sanitary pads prochlorperazine OCP doxycyline
What are the symptoms of medical abortion?
vaginal bleeding
lower abdo pain
After how long will abortion symptoms take place after misoprostol?
2-3 hours
What is the benefit of surgical over medical?
minimal abdo pain
minimal vaginal bleeding
coil can be fitted (IUC)
smear can be done
After how long following an abortion are you fertile again?
after 5 days following abortion
What is the surgical procedure for abortion?
suction device
Three contraindications for medical abortion?
long term corticosteroids hypertension adrenal insufficiency sickle cell high cholesterol
List two contraindications for surgical abortion
BMI 40
BMI 35 with comodrbidities
Anaesthetic complications
Difficulty of accessbility e.g. cervical tumour
List three complications of abortion
failure to end pregnancy retained non viable tissue infection haemorrhage cervical tear uterine perforation pscyhological impact
When should you seek medical attention following an abortion?
very heavy bleeding
symptoms of anaemia: dizziness, SoB, palpitations
Offensive vaginal discharge
High fever and systemically unwell
Which questions should you ask presenting to A&E with vaginal bleeding who had an abortion three weeks ago?
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?
Differential diagnosis for vaginal bleeding post abortion?
incomplete abortion
endometritis
uterine perforation (if surgical)
side-effect of contraception
What is RPOC?
retained products of conception
Would RPOC have a positive or negative pregnancy test?
positive
What is the management of RPOC?
Watchful waiting
further misoprostol
surgical
How is RPOC diagnosed?
clinical + USS
What are the signs and symptoms of endometritis?
persistent lower abdo pain pain with intercouse persistent bleeding offensive vaginal discharge fever
What is the management of endometritis?
broad spectrum abx
analgesia
If sepsis- admit, IV abx, IV fluids
What is a conscientious objection?
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
What year is the most recent abortion act?
Abortion act 1967
