Termination Flashcards
A 14-year-old girl attends the After Hours Medical Centre with her boyfriend. She is 7 weeks pregnant and requests a termination. The legal requirement of the doctor who sees her is to:
a) Pregnancy help services
b) Contact the police because she has been sexually active and is a minor
c) Refer her to a certifying doctor who can arrange for counselling and pregnancy termination
d) Ascertain what the boyfriend wants to do about the pregnancy
e) Contact the girl’s parents and inform them of her pregnancy
c) Refer her to a certifying doctor who can arrange for counselling and pregnancy termination
An 18-year-old woman has just had her second termination of pregnancy. She had chlamydia diagnosed and treated prior to the termination procedure. She has had multiple partners. She has a family history of thrombophilia affecting her mother and sister during pregnancy. Given her circumstances, the most appropriate contraception for her is:
a) Copper Intrauterine contraceptive device
b) Contraceptive Implant
c) Condoms
d) Combined oral contraceptive pill
e) Progesterone only pill
b) Contraceptive Implant
Which of the following statements regarding TOP (termination of pregnancy) is true?
a) Since legal abortions have been available in New Zealand no woman has died as result of TOP
b) Women undergoing medical TOP do not have to see 2 certifying consultants
c) There is good evidence to support an increase in breast cancer with TOP
d) Fetal abnormality is a ground for TOP after 20 weeks
e) All women seeking a pregnancy termination must legally undergo counselling
a) Since legal abortions have been available in New Zealand no woman has died as result of TOP
Margaret, aged 48, has come to see you, her GP, to seek referral for consideration of TOP (termination of pregnancy). She is 10 weeks pregnant. You give her the following advice. Which of the following statements is INCORRECT?
a) Extremes of age are not grounds for TOP
b) Medical abortion is containdicated in this case
c) Before referral she need to do antenatal bloods and have swabs taken
d) Complications of TOP include perforation of the uterus
e) Under the CSA act she will need to see 2 certifying consultants.
c) Before referral she need to do antenatal bloods and have swabs taken
Your primigravid patient was admitted at 17 weeks gestation for termination of abnormal pregnancy. 48 hours prior to admission she had taken Mifepristone 200 mgm. After 5 doses of misoprostol ( 400mcg 3 hourly) she had not passed any products and the cervix was found to be long and closed. She had wanted to see the baby after the delivery but understood registration was not legally required. In planning the ongoing management, which is most likely to be the most efficacious way of completing the abortion in her case.
a) Prescribe oral misoprostol
b) Commence Oxytocin infusion
c) Repeat the mifepristone-misoprostol regimen
d) Plan surgical evacuation after using a dilapan rod in the cervix
e) Rupture the membranes and commence oxytocin infusion
c) Repeat the mifepristone-misoprostol regimen
A healthy 29 year old Gravida 3 parity2 women was admitted to the assessment ward 3 days after a suction termination of pregnancy done at 10 weeks gestation. She was concerned about heavy bleeding having had light bleeding for the first 2 post termination days but then had used 6-8 pads over the past 18 hours. She had no pain, the temperature was normal. On examination there was some blood clot in the cervix. The most appropriate plan is to:
a) Admit and arrange evacuation of the uterus
b) Reassure, explain that the bleeding is expected as the decidua is shed
c) Admit for antibiotics and arrange a pelvic ultrasound scan
d) Prescribe antibiotics and arrange a pelvic ultrasound scan as an outpatient
e) Reassure, given the normal vital signs and absence of tissue in the cervix
b) Reassure, explain that the bleeding is expected as the decidua is shed
You are explain the role of ultrasound scanning after early abortion.
Which of the following statements is correct?
a)The positive predictive value of ultrasound for need for evacuation is high
b) The positive predictive value of the ultrasound diagnosis of retained tissue is high
c) Ultrasound reliably confirms expulsion of the gestation sac
d) Endometrial thickness >12mm indicates need for evacuation
e) Endometrial thickness > 15 mm confirms retained products of conception
c) Ultrasound reliably confirms expulsion of the gestation sac
A previously healthy 22 year old woman underwent a medical termination of pregnancy at 7 weeks gestation. She experienced pain and bleeding, passed tissue and the bleeding seemed to have settled and she has no pain now. She had a progestagen implant inserted for contraception. On the day 10 follow up the βHCG is 200IU.The most appropriate plan for follow up is:
a) Arrange surgical evacuation with histology for molar pregnancy now
b) Arrange an ultrasound scan now
c) Repeat the βHCG in 4 days
d) Prescribe misoprostol to ensure complete evacuation of the uterus
e) Admit for laparoscopy now to exclude ectopic pregnancy
c) Repeat the βHCG in 4 days
An anxious 17 year old college student did her own pregnancy test 2 weeks after she had an abortion at 10 ½ weeks gestation. The test was positive. She had an implant inserted at the time of the termination. Within a couple of days of the termination she noticed that the vaginal bleeding was light and has remained so. She has consulted your- her GP now, worried that she is still pregnant.The most appropriate plan now is to:
a) Repeat the HCG now
b) Reassure her that everything will be all right as the abortion service is very experienced
c) Arrange an urgent ultrasound scan to exclude ongoing pregnancy
d) Arrange to see her, enquire about symptoms and perform a pelvic examination
e) Reassure her as HCG takes a long time to clear, enquire about symptoms and arrange to see her should she remain concerned.
e) Reassure her as HCG takes a long time to clear, enquire about symptoms and arrange to see her should she remain concerned.
A 22 year old G3 P1 had a surgical termination of pregnancy at 9 weeks gestation and a contraceptive implant was inserted. Now 3 weeks later, she has continued to have vaginal bleeding using 2-3 pads per day. She is otherwise well. She is becoming “fed up” with the inconvenience and wants you, her GP, to take the implant out. What would you advise in this situation? Give the answer you think best.
a) Arrange to remove the implant now
b) Arrange to remove the implant and start Depo-Provera injections
c) Arrange an ultrasound scan to exclude retained products
d) Offer reassurance that this will settle, but start Depo-Provera
e) Offer reassurance that this will most likely settle but offer treatment if it has not settled within the next 2-4 weeks
e) Offer reassurance that this will most likely settle but offer treatment if it has not settled within the next 2-4 weeks
A 23 year old conscientious university student had a medical termination of pregnancy at 6 ½ weeks gestation. She thought she had passed all the tissue at home and she felt well. She did a follow up HCG test 2 days later which showed a low HCG. She was having very light bleeding. Ten days later she noticed an increase in bleeding and cramping lower abdominal pain severe enough for her to miss classes. The Student Health doctor is seeking advice for the gynaecology Senior House Officer about what to do.What is the most appropriate advice in this situation?
a) Reassure her that this is normal as the decidual lining of the uterus is being passed.
b) See her now , examine her and repeat the HCG urgently
c) Arrange a pelvic ultrasound and see her when this is available
d) Arrange a bHCG and see her when this result is available
e) Arrange for her to be admitted to hospital
b) See her now , examine her and repeat the HCG urgently
You are managing a 32 year G1 P0 women at 23 weeks gestation who is undergoing a medical termination of pregnancy after her fetus was found to have a major congenital abnormality, incompatible with life. She had had Mifepristone 200mgm, 48hours prior to this admission. She has had 5 doses of Misoprostol and the fetus is undelivered. Vaginal examination shows the cervix to be closed. She asks what the evidence is for the best plan is now.You answer:
a) Continue the misoprostol now for another 5 doses
b) Start a syntocinon infusion
c) Go to theatre for a hysterotomy under general anaesthesia as this is kindest approach now.
d) Have a break, then repeat the mifepristone and misoprostol as most women will deliver with this regimen
e) Go to theatre, insert an osmotic dilator in the cervix and start misoprostol the next day
d) Have a break, then repeat the mifepristone and misoprostol as most women will deliver with this regimen
