C4

Question 1

Abortion Act 1967

Answer 1

2 medical professionals (need to sign HSA1 form)

1. Pregnancy < 24 weeks
2. Continuing the pregnancy is a greater risk than termination and injury to mental or physical health to her or any other children
3. Prevent grave permanent injury to physical or mental health
4. Risk life of pregnant woman
5. Substantial risk if the child is prn would suffer from abnormalities that would causes serious handicap

There is no upper limit on gestation if due to 2,3, or 4

Question 2

When can termination be granted in under 16s

Answer 2

Without parental consent if:

• Understand all aspects and implications
• Cannot persuade them to tell parents
• Physical or mental health with suffer if they don’t
• Best interests to receive without parental consent

Question 3

What should happen before a termination?

Answer 3

Confirm pregnancy

Discuss methods and choices available

Consider alternatives

Allow time for decision (but earlier has less complications)

Screen for chlamydia and STIs (positive in 13%)

Discuss future contraception

Check Rh status

Check if requires smear

Question 4

Describe conscientious objection of abortion

Answer 4

Section 4 of Abortion Act

Can refuse

Must provide treatment necessary to save a life

Must explain the objection

Cannot express disapproval

Question 5

Epidemiology of Down’s syndrome

Answer 5

1 in 1500 at 20 years
1 in 100 at 40 years
>1 in 50 at 45 years

Question 6

Screening methods for Down’s syndrome

Answer 6

1. Serum screening at 10 to 14 weeks
2. Ultrasound - nuchal translucency at 11 weeks to 14 weeks
3. Quadruple test at 14 to 20 weeks

Once a test has been performed, the chance of the foetus having Down’s is calculated.

If > 1 in 150 then offer diagnostic testing.

• Amniocentesis at 12 to 18 weeks (most common after 15 weeks)
• Chorionic villus sampling at 11 to 13 weeks

Question 7

Who provides antenatal care?

Answer 7

If uncomplicated - midwife and GP led

Small group of medical professionals

Women should carry their own case notes

10 visits - uncomplicated nulliparous

7 visits - uncomplicated multiparous

Question 8

What do the outcomes framework monitor in relation to pregnancy?

Answer 8

Infant mortality (up to 1 year)

Perinatal mortality (including stillbirths), pregnancy, immediately after birth

Question 9

Define fertility rate

Answer 9

Births per 1000 women per year aged 15-44

Question 10

Define number of conceptions

Answer 10

Total maternities + legal abortions + admissions for miscarriage + ectopic pregnancy

• 75% are live or stillbirths
• 18% legal termination
• 7% miscarriage or ectopic

Question 11

Define maternity

Answer 11

Any pregnancy that results in birth of live or still born child

Question 12

Define live birth

Answer 12

Complete expulsion of product of conception from mother, regardless of duration which shows any signs of life
- HR, breathing, umbilical cord pulsation, movement

Question 13

Define abortion

Answer 13

Complete expulsion of foetus showing no signs of life prior to 24 weeks gestation

Question 14

Triennial report - types of maternal mortality

Answer 14

Direct - death from obstetric complications

Indirect - resulting from previous existing disease, aggravated by pregnancy

Fortuitous - incidental but during pregnancy