Emergency Contraception Flashcards
What age group has the highest rates of TOP?
20-24year olds
What are the terms of the abortion act 1967?
needs 2 registered medical practitioners to sign off; must take place in NHS hospital
What form must be filled out for an abortion?
certificate A (HSA1)
What form must be filled in within 24 hours of an emergency abortion?
certificate B (HSA2)
What forms must be completed and sento t the CMO within 7 days of the abortion?
HSA4
What is the most common ground for termination used in certificate A?
pregnancy has not exceeded 24th week and continuane of pregnancy would invovle risk, greater than if pregnancy terminated, of injury to physical or mental health of pregnant woman
How long does it take to be referred for TOP consultation?
2 weeks
When is the legal limit for social TOP?
23 weeks 6 days
What is the limit for medical termination in Tayside?
18 week and 6 days
What is the limit for surgical termination for Tayside?
upto 12 weeks
What is defined as early medical temrination?
upto 9 weeks
What is defined as late medical termination?
9-12 weeks
What is mid-trimester termination?
12-24 weeks
What is the first stage in medical TOP?
oral mifepristone 200mg
What is mifepristone?
anti-progesterone
What is the second stage of medical TOP?
vaginal or oral prostaglandin eg misoprostol
HOw long after the first stage does the second stage of TOP take place?
24-48hours
What option is there for early medical TOPs~?
complete 2nd part at home
What is required for late-mid-trimester medical TOPs?
repeated doses of prostaglandin 3 hourly
What is the surgical option 6-12 weeks?
vacuum aspiration
What is the surgical option available in London between 13-24 weeks?
dilatation and evacuation
What tx is required before surgical TOP?
cervical priming with vaginal prostaglandin
What is manual vacuum aspiration?
new alternative for early TOP performed under LA
What are the complications of TOP?
pain; haemorrhage; infection; imcomplete/failed; uterine perforation; cervical trauma; anaesthetic complications; uterine rupture
How long after TOP should a repeat UPT be done?
2-3 weeks
What contraceptives can be started immediately after TOP?
pills; injection; implant; IUD- depends
What is the mid-cycle pregnancy risk following UPSI?
around 30%
After how many missed COC should EC be taken?
more than one
What are the oral methods of EC?
LNG-EC and UPA-EC
What is the difference between LNG-EC and UPA-EC?
LNG upto 72hours post UPSI whereas UPA upto 120hours
What intrauterine method is available for EC?
copper IUD
What is the mode of action of oral EC?
delay ovulation
Does LNG or UPA have a higher pregnancy rate after use?
UPA
When is LNG most effective?
first 24 hours
What is UPA?
anti-progestogen
What is LNG?
high dose progestogen
Which oral EC can work during LH surge but not after peak?
UPA
When should UPA be avoided?
if wishing to start quick-start contraception- must delay for 5 days; if hormonal contraception has been used in past 7 days; severe asthma
What is the effectiveness of the copper IUD compared with oral ECs?
10x more effective
What are the mode ofactions of the copper IUD?
toxic to sperm and ovum; anti-implantation
When can the copper iuD be inserted?
upto 120 hours post-UPSI; upto 5 days after earlist expected date of ovulation
When do most pregnancies implant after fertilisation?
8-10days
How often can levnorgestrel vs ulipristral be given in a cycle?
LNG- repeatedly; ulipristal- once
What is the difference in time effectiveness between LNG and ulipristal?
LNG is time-dependent whereas ulipristal is not
What drugs can ulipristal acetetate not be given with?
liver enzyme inducers; drugs reducing gastric pH; less effective if on hormonal contraception
Is ulipristal suitable whilst breastfeeding?
CI for a week
