L16 Termination of pregnancy Flashcards

1
Q

How many categories are the legal basis for 2 doctors to sign off for abortions?

A

5 main ones and 2 emergency ones

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2
Q

Ground A

A

The continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy was terminated

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3
Q

Ground B

A

The termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman

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4
Q

Ground C

A

The pregnancy had NOT exceeded 24 weeks and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman

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5
Q

Ground D

A

The pregnancy has not exceeded 24 weeks and the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of any existing children

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6
Q

Ground E

A

There is substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped

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7
Q

Ground F (emergency)

A

To save the life of the pregnant woman

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8
Q

Ground G (emergency)

A

To prevent grave permanent injury to the physical or mental health of the pregnant woman

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9
Q

Gestation and termination of pregnancy

A

By law you can terminate a pregnancy at any gestation under grounds A,C,E,F,G

But very rare over 24 weeks
-viability - changed from 28 weeks when law commenced

If under E and after 24 weeks usually perform foeticide first

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10
Q

What year was the abortion act made?

A

1967

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11
Q

UK statistics

A

92% of abortions were carried out at under 13 weeks in 2014/2015/2016

81% were under 10 weeks in 2016; compared to 80% in 2014, 79% in 2013 and 68% in 2008

In England and Wales the number of TOPs has declined since 2006, including under 16 abortion rates

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12
Q

Stats for grounds for abortion

A

180,794 (97%) carried out under Ground C (99.8% mental health)

1342 (1%) carried out under Ground D

3,208 abortions (2%) were carried out under ground E (risk child born handicapped)

246 under Ground A and B

6 cases under Ground F or G

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13
Q

Trend of abortions since 1967-2016

A

general increase indicating rising rates of terminations or better collection of data

has started to flatten out

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14
Q

Doctor’s right to choose - conscientious objection to participation in treatment

A

No person shall be under any duty to participate in any treatment authorised by this Act to which he has a conscientious objection

Nothing shall affect any duty to participate in treatment which is necessary to save the life or to prevent grave permanent injury to the physical or mental health of a pregnant woman

Doctors with a conscientious objection still need to complete the paperwork including consent but not the legal form and care for the patient after termination

They have a duty to refer the patient to another doctor for the procedure

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15
Q

Age related terminations

A

Peak age to have abortion around 20-24

then declines

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16
Q

Place of termination from 1981-2015

A

Decrease in the amount privately funded

Increase in NHS funded

17
Q

Terminations

A

Free on the NHS

Carried out within a licenses clinic

Referral via GP/family planning doctor (2 doctors sign the abortion act form)

Discussion re whether 2 doctors are required

Post termination contraception

Chlamydia screening

18
Q

Surgical abortion

A

Usually under 12-14 weeks
Vacuum aspiration
GA or local anaesthesia

Over 14 weeks (rare)
Dilation and evacuation

19
Q

Medical abortion

A

Progesterone antagonist (mifepristone) orally: stop the pregnancy

Combined with misoprostol (prostaglandin E1 analogue) vaginally: start uterine contractions

Abortion occurs usually 2-6 hours after misoprostol

In UK legal restrictions on place of administration of these drugs: Under 9 weeks can take both tablets at home. Over 9 weeks the misoprostol is inserted in the clinic but still can go home

20
Q

Risks with abortions

A

Mortality 0.6 deaths per 100,00 abortions (no deaths in 2014 but 1 in 2015 and 1 in 2016)

Failure: 0.2% after surgical and 0.7% after medical

Incomplete abortion (1%), excessive bleeding (0.1%), uterine damage (surgical) (0.5%), infection (<1%)

21
Q

Long term sequelae

A

No association between abortion and

  • ectopic pregnancy
  • infertility
  • placenta praevia
  • preterm birth
  • psychological effects