Termination of Pregnancy Flashcards
Managing Unplanned pregnancy (3)
- Early diagnosis of pregnancy is ideal
** Counselling
non directive & non judgemental
enable woman to voice doubts and concerns
** Explore options and provide informationExplore options and provide information
Continue pregnancy and keep baby
Continue pregnancy and give baby for adoption
Abortion
Abortion Care Methods available in Weeks (6)
- Early medical abortion(MTOP) 9 +6
-Manual Vacuum Aspiration(MVA) 9 +6
- Suction Termination (STOP) upto 14
- Dilatation & Evacuation 15 – 18
- Mid-trimester medical abortion 14 – 24
- Two stage surgical procedure 19 – 24
Early medical abortion (4)
Medical abortion using Mifepristone plus prostaglandin is an appropriate method at any gestation under 9 weeks
** Mifepristone 200mg PO - 24 – 36 hrs later
** Misoprostol 800mcg PV
** Given for gestations between 9 and 12
** Can be given
Reasons for Early medical abortion (6)
- Seemed a more ‘natural’ experience
** No surgery or Anaesthesia was needed
** It afforded more privacy
** Perceived to be less frightening and
easier emotionally than a surgical abortion
** Required a shorter stay in hospital
** It was easier, simpler and faster
Suction termination (4)
- Suction termination of pregnancy should be avoidedat gestations of <7wks-No longer the case
** Conventional suction termination is an appropriate method at gestations of upto 14 weeks
** Cervical preparation is beneficial prior to suction termination
** Suction termination may be safer under local anaesthesia than general – Manual Vacuum anaesthesia Aspiration (MVA)
Induced Abortion Complications during the procedure (6)
Immediate
** Anaesthetic
** Uterine perforation - 0.8 / 1000
** Cervical Tears
** Primary haemorrhage
** Uterine rupture
** Death - rare - 0.6 / 1,000,000 extremely rare event
Induced Abortion- after discharge complications (very rare) (5)
- Retained products of conception ~ 1 : 100
** Secondary haemorrhage
** Pelvic infection
** Failed abortion
** Ectopic pregnancy
Induced Abortion- complication + prevention (5)
Late
** Tubal factor infertility
** Screening and Antibiotics - prevention
** Rhesus Iso-immunisation - Blood group and antiD adminstration
** Psychological and psychosexual sequelae
** Counselling support and options to patients
Abortion care - Prevention of STIs (3)
Screen all women - opt out policy
Chlamydia
Gonorrhoea
Syphilis
HIV
Treat positives and contact tracing to screen and treat partners if they too are infected
This will help with impact on their health and future fertility
Induced Abortion - Psychological sequelae (4)
- Regret and early distress common
** Adverse sequelae occur only in a minority
** Continuation of problems present before
abortion
** Long term post abortion distress risk factors
Unsupportive partner
Ambivalence before abortion
Prior psychiatric history
Considers abortion wrong
Induced Abortion- Aftercare (7)
- Anti-D prophylaxis
** Written information
** Contact numbers for support
** Counselling services
** STI services follow up
** Contraception advice and provision
** Follow up appointment within 2 weeks optional
LARC - long acting reversible contraceptive benefit
if 7% of women switched from the contraceptive pill methods to LARC (defined as the intrauterine device (IUD), hormonal injection, intrauterine system (IUS) and contraceptive implant)
= the NHS could save around £100 million through reducing unintended pregnancies by 73,000.
In February, 08/09 the Public Health Minister, announced £26.8m new funding for from the Comprehensive Spending Review to improve access to contraception.
History (1967-2022): (9)
1967 - abortion act - legalised on certain grounds
1990 - Human Fertilisation and Embryology Bill dec. gestation limit for abortions 28->24wks
2017 - NI funded abortions in UK
2018 - women of Wales. England, Scotland could take 2nd pill (misoprostal) at home
2018 - abortion legalised on certain grounds up to 12wks + later is woman’s life/health at risk (irish republic)
2019 - abortion decriminalised in NI
2020 - Women in England and Wales can take both abortion medications, mifepristone + misoprostol, at home, without the need to first attend a hospital or clinic
2020 - new legal framework for abortions NI
2022 - women of wales can take both @ home permanently now
Medical + surgical abortion rates (2)
medical increased
surgical decreased
negative correlation
Group A - abortion
That the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated.
Group B- abortion
That the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
Group C - abortion
That the pregnancy has NOT exceeded its 24th week 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
Group D - abortion
That the pregnancy has NOT exceeded its 24th week 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 any existing child(ren) of the family of the pregnant woman
Group E - abortion
That there is substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped
Group F - abortion
To save the life of the pregnant woman
Public opinion on abortion
Public opinion supports abortion when a pregnancy is unwanted
Abortion Care – who are the providers? (3)
NHS funded - NHS hospital
NHS funded - Independent sector
Privately funded
Feticide (2)
For abortions at 22 weeks or beyond, feticide is recommended prior to the
evacuation of the uterus to stop the fetal heart.
In 2012, of the 1,312 abortions performed at 22 weeks and over
Selective termination (3)
In 2012, -82 abortions:
38 cases, two fetuses were reduced to one fetus.
28 cases, three fetuses were reduced to two fetuses
11 cases three fetuses were reduced to onefetus.
Working Together to Safeguard Children April 2006 (4)
Individual risk assessment in each case of underage sex
** Under 13s should be discussed with the child protection lead in your organisation and fully documented, including reasons where a decision is made not to share information
** Under 16 – an assessment is made to see if the person understands – Gillick Competent
** Local protocols should be developed
Late Abortion (4)
% of abortion at 20 or more weeks is small around 1-1.6%
More in younger women compared to older.
2.3% of all abortion in under 20’s were at 20+ weeks compared to 30 – 39(1.4%).
60% of these were NHS agency abortion
Specific reasons reported for late presentation e.g.’s
Reasons for seeking abortion late (5)
Delay in suspecting pregnancy
Delay in taking pregnancy test
Delay in deciding to have an abortion
Delay in asking for an abortion
Delay in obtaining an abortion
Fetal Sentience (3)
Between 12 and 40 wks phenomenal changes occur.
Fetus is sensitive to touch from 7 weeks and can move its limbs. These movements are spinal reflex responses and not dependant on brain activity.
Therefore unlikely to contain any conscious component. Only after 26 weeks does this give way to more definitive actions.
Perception of pain (2)
feelings and emotions are not given directly by the brain but arise from repetitve experiences. Therefore concept of fetal pain should be rejected.
We cannot propose different sentient stages for smiling and crying so debate around 4D images should be rejected
Should we lower the maximum age for abortion? (2)
Of those born at 24 weeks, 47% survived after being admitted to neo-natal units - some would have died on the labour ward - compared to 35% in 1995, and at 25 weeks, 67% lived compared to 54%.
But of those born at 23 weeks the increase from 19% to 26% was not deemed
statistically significant as the numbers of babies involved was too small
Morbidity is an issue too - Severe long term Disability (3)
23 wks - 67%
24 - 38%
25 - 20%
