Chapter 20: Therapeutic Abortion Flashcards
You are a trainee intern working in a Family Planning with a registered nurse mentor. Your next client is Eleanor who is a 23 year old G1P0 Chinese cis female who has come to discuss pregnancy options. She is on Depo Provera (DP) for contraception but had her last injection late, and had been at risk of pregnancy. A pregnancy test at her last consultation was negative and was advised by the nurse to repeat the test in 4 weeks, which was positive. Eleanor is shocked by the result and not sure what to do. She has always been very uncomfortable with the idea of abortion as it is inconsistent with her faith, but now that she finds herself in this situation isn’t ruling it out as an option. In this situation what are you legally obliged to do?
Discuss possible teratogenic effects with DP
Advise Eleanor that counselling is available
Refer to an abortion provider just in case
Report the use of DP in pregnancy to CARM
Advise Eleanor to seek support from her church
Advise Eleanor that counselling is available
You are a trainee intern working in a rural practice with a nurse practitioner mentor. You have been asked by the NP to see Lesley who is a 28 year old G1P0 English person who identifies as non binary. They have done a home pregnancy test which was positive. Lesley thinks they are about 7 weeks by dates and has already decided to have an abortion which they would like to get done as quickly as possible. Lesley and their partner own their own business and are incredibly busy. You arrange for Lesley to do self-swabs and the NP does a point of care ultrasound to confirm dates and ensure an intrauterine pregnancy. The only thing left to do is get bloods taken which the NP asks you to do. Lesley asks what the antenatal bloods are checking for. What do you advise?
Blood group/rhesus status, syphilis, Hepatitis B&C, rubella immunity, haemoglobin, HIV, HbA1c, antibody screen
Blood group/rhesus status, syphilis, Hepatitis B, rubella immunity, haemoglobin, HIV, HbA1c, liver function tests
Blood group/rhesus status, syphilis, Hepatitis B, rubella immunity, haemoglobin, HIV, HbA1c, HCG
Blood group/rhesus status, syphilis, Hepatitis B, rubella immunity, haemoglobin, HIV, HbA1c, antibody screen
Blood group/rhesus status, syphilis, Hepatitis B, rubella immunity, haemoglobin, HIV, HbA1c, ferritin
Blood group/rhesus status, syphilis, Hepatitis B, rubella immunity, haemoglobin, HIV, HbA1c, antibody screen
You are a trainee intern in a general practice with Mila, an 20 year old G1P0 Pākehā cis female person who is unexpectedly pregnant. She stopped the pill about 10 weeks ago when she broke up with her boyfriend but did have sex with a friend about 8 weeks ago and is pretty sure they didn’t use a condom. Since having a withdrawal bleed when she stopped the pill 10 weeks ago she hasn’t had any bleeding since. A pelvic ultrasound confirms that Mila is about 8 weeks pregnant. Mila has decided she would like a surgical abortion and your GP mentor is arranging for this at the local abortion clinic. Mila asks you “what exactly happens during a surgical abortion?” Which of the following statement regarding a first trimester suction aspiration abortion is TRUE?
You will be given methotrexate to soften the cervix about 1hr prior to the procedure
Laminaria will be placed into the cervix the day before to soften and dilate the cervix
The most common form of pain relief during a suction aspiration abortion is general anaesthetic
A soft plastic tube is introduced into the cervix to aspirate (suck out) the contents of the uterus
You will need to be admitted overnight to hospital for observation but can go home the next day
A soft plastic tube is introduced into the cervix to aspirate (suck out) the contents of the uterus
You are a trainee intern on your O&G attachment and have been asked to go to the ED to see 13 year old Kaia, a young Pākehā cis female who has presented with generalised lower abdominal cramps which have kept her awake the last couple of nights. Kaia has an older sister with her for support.. Kaia tells you that she has not had a period for at least two months and has not been using contraception. Her observations and abdominal examination are unremarkable. A urine pregnancy test is positive and a trans-vaginal ultrasound confirms a 10 week viable intrauterine pregnancy and no abnormal findings. When you discuss your findings with Kaia she tells you she knew she was pregnant and has already decided she wants an abortion and her sister will support her. During the consultation you ascertain that Kaia is Gillick competent. Of the following options what is the most important management advice about the pregnancy?
Watch out for increasing pain or bleeding
Provide details for self-referral to abortion service
Notify Kaia’s parents of the pregnancy
Arrange a non-urgent appointment to see GP
Attend for follow-up at the early pregnancy clinic
Refer Kaia to pregnancy counselling services
Provide details for self-referral to abortion service
You are a trainee intern working with a GP in general practice. You have been asked to see Lilly (uses she/her pronouns), a 16 year old Māori young person, who presents with her Aunty for support. Lilly is 2 weeks late for her period, which are normally 28 days regular and she is concerned she may be pregnant as she has been having unprotected sex. You do a pregnancy test which is positive and Lilly is upset but unsurprised at the news. Lilly’s Aunty states that the whanau wish to take on the child as a whāngai (customary adoption or fostering). What should the next step be?
Arrange a dating scan and give a list of midwives
Ask Lilly to do STI swabs as she has been at risk
Arrange a form for Lilly to do first antenatal blood
Ask to speak to Lilly alone to clarify her wishes
Refer her to a Social Worker to discuss with Oranga Tamariki
Enquire as to what the whāngai arrangements will be
Ask to speak to Lilly alone to clarify her wishes
You are a trainee intern on placement in a sexual health clinic. Your next patient is Tania, a 26 year old Pākehā person (uses she/her pronouns) who has done a positive home pregnancy test and by LMP she is approximately 8 weeks pregnant. Tania has recently accepted a job offer to work in her “dream job” in Australia and having a child at this point in her life may mean she has to give up this opportunity. She does feel she could not continue the pregnancy and give the child up for adoption. Tania has already considered her options and is definite she wants an abortion. What do you advise regarding having an abortion?
She needs to prove that continuing the pregnancy would cause her mental or physical harm
Tania needs to reconsider the Australian job opportunity and refer her to a pregnancy counselling service
She needs to see two certifying consultants who must agree the abortion is in her best interest
Having an abortion is a big decision and she should come back to see you in a week when she has had more time to think
Before having an abortion Tania needs to talk to the father of the pregnancy and ensure he is OK ending the pregnancy
To have an abortion is completely her choice and she doesn’t need a particular reason
To have an abortion is completely her choice and she doesn’t need a particular reason
You are a trainee intern working in an abortion clinic providing comprehensive abortion services. You are seeing Sun who is an 18 year old Chinese university student (uses she/her pronouns) studying law and has an unintended pregnancy of 8 weeks. Sun has self-referred for an abortion and is asking about her options for how she can have an abortion. At 8 weeks gestation, Sun can be offered which of the following options?
Early medical abortion using misoprostol only
Early medical abortion using methotrexate and misoprostol
Surgical suction aspiration under local anaesthetic and sedation
Surgical suction aspiration under general anaesthetic
Either early medical abortion or surgical abortion according to her wishes
Early medical abortion using mifepristone and misoprostol
Either early medical abortion or surgical abortion according to her wishes
You are a trainee intern in general practice and are assisting your GP mentor to assess 19 year old Ellie, who identifies as cis female of Pākehā descent who has been brought in by her mother. Ellie had a surgical abortion 2 days ago at 10 weeks gestation. Ellie has a 4 hour history of feeling increasingly feverish and unwell, and has been experiencing crampy pelvic pains and is passing clots. You note that Ellie looks distressed, pale and unwell. Her observations are bp 90/52, pulse 130 and temperature of 38.5, Your GP mentor asks you to put in an IV line. You have a moral and ethical opposition to abortion. What is the right course of action?
Get the practice nurse to put the line in instead
Tell your mentor that you cannot assist due to your objections
Offer to see the next patient because the clinic is now running late
Phone the ambulance but decline to assist in hands on care
Phone your course convenor to ask for advice in this situation
Provide the necessary care despite your objections
Provide the necessary care despite your objections
You are a trainee intern in a rural general practice with Jacks, a 24 year old G1P0 Pākehā trans-masculine person who you saw two weeks ago and arrangements were made for him to be seen at the local abortion clinic. He now presents with bleeding like a period, five days after a surgical abortion at 10 weeks gestation under local anaesthesia and sedation. There were apparently no complications during the procedure. For three days after the procedure, he had very little spotting and no pain, but then yesterday had bleeding, like the start of a period, and this morning heavier bleeding (but still lighter than a period) with some vague generalised pelvic discomfort. He has not required analgesia, feels well, and has no febrile symptoms. Jacks is anxious about complications. From the following options, what is the most likely diagnosis based on this history alone?
Degenerating corpus luteum
Retained products of conception
Acute clot retention
Uterine perforation
Acute endometritis
Degenerating corpus luteum
You are a trainee intern in a Family Planning placement working with one of the nurses for the day. You are seeing Melody who is a 18 year old, G1P0 Pasifika cis female woman who has had a positive pregnancy test and is approximately 8 weeks by dates. You and the nurse you are working with have arranged, antenatal bloods, ultrasound and referred her into the abortion service. As Melody has been at risk of STIs she also agreed to a swab for chlamydia and gonorrhoea. You have discussed the immediate risks of having a medical abortion. Melody then asks you if there are any long-term risks associated with medical abortion? From the following options, what do you reply?
Evidence suggests that people who have abortions are at risk of depression post abortion
When you are pregnant again, you have a slightly increased risk of preterm birth
You have no risk of any long term complications because you are young and fit
Your risk of infertility is low because we have done an STI screen today
The risk of infertility is less than 1%, which is the same as if you continued the pregnancy to term
The risk of infertility is less than 1%, which is the same as if you continued the pregnancy to term
You are a trainee intern at an antenatal clinic seeing Maia, a 36 year old G3P2 Samoan cis female with no previous health problems. Maia is 21 weeks pregnant and has only just returned with her family from a remote Samoan Island where pregnancy was diagnosed two months ago. She has just had an ultrasound this morning and the fetus is diagnosed as having a severe fetal neural tube defect. She and her husband request an abortion. From the following options, what is the most important legal requirement to be satisfied if Maia wishes to proceed with an abortion?
Maia can legally opt to have an abortion without anyone making this decision on her behalf
The abortion procedure must be carried out before viability at 24 weeks gestation
A qualified health practitioner must believe that the abortion is clinically appropriate and must consult with another qualified health practitioner
Maia must commence a reliable form of contraception following the abortion
Maia must request her GP or Family Planning clinic to refer into the abortion service
A qualified health practitioner must believe that the abortion is clinically appropriate and must consult with another qualified health practitioner
Cynthia is a 22 year old G1P0 Māori cis female who has an unintended pregnancy of 6+3 by ultrasound. She usually has regular monthly cycles but lost track of when her last period was when she became busy with work and was astonished to find she was pregnant. Cynthia has been using condoms for contraception and was not aware of any unprotected sex/condom failures. Cynthia is wanting to explore her options for abortion. Her antenatal bloods come back showing she is Rhesus negative. What is the best answer regarding administration of Anti-D in early medical or surgical abortion?
You should have anti-D regardless of whether you have an early medical or surgical abortion
If you have an early medical abortion you do not need anti-D because you are less than 10 weeks
You should have an early medical abortion to reduce the risk of isoimmunisation
Anti-D is required for all rhesus negative women who are more than 7+6 to avoid isoimmunisation
Because this is your first pregnancy you don’t need anti-D, but should have it for a subsequent pregnancy
If you have an early medical abortion you do not need anti-D because you are less than 10 weeks
fetal blood cells into circulation wont cause sensitisation.
You are a trainee intern working with a GP mentor in general practice. Miriam is a 32 year old African cis female woman who is requesting an abortion for an unintended pregnancy. She already has 3 children and feels that her family is complete. Miriam and her husband both work full time to provide for their family and do not feel in a position to care for another child. You have already arranged a dating ultrasound and Miriam asks you whether she needs any other tests done? Which of the following are routine tests prior to having an abortion?
First antenatal bloods, cervical smear, chlamydia/gonorrhoea genital swab
First antenatal bloods, high vaginal swab, chlamydia/gonorrhoea genital swab
High vaginal swab, chlamydia/gonorrhoea first void urine, cervical smear
Chlamydia/gonorrhoea genital swab, HVS, HCG, first antenatal bloods
Chlamydia/gonorrhoea genital swab, cervical smear, HCG, first antenatal bloods
First antenatal bloods, high vaginal swab, chlamydia/gonorrhoea genital swab
