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reproduction > termination of pregnancy > Flashcards

termination of pregnancy Flashcards

1
Q

abortion care methods available in 9+6

A

9+ 6 = 9 weeks and 6 days so 10 weeks
1. early medical abortion (MTOP) -
2. Manual Vacuum aspiration (MVA) -local procedure in clinic, local block on cervix , put a big syringe and use vacuum.

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2
Q

abortion care methods available upto 14 weeks

A

suction termination (STOP) - patient is asleep and vacuum out

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3
Q

abortion care methods available 15-18 weeks

A

dilation and evacuation - dilate the cervix

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4
Q

abortion care methods available 14-24 weeks

A

mid- trimester medical abortion - tablets
-in the second trimester

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5
Q

abortion care methods available in 19 -24 weeks

A

two stage surgical procedures
- dilate for 24hrs
-then put a tube and evacute

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6
Q

Patient had sex 2 weeks ago and had her period 3 weeks ago and has a positive pregnancy test so how is her pregnancy time calculated?

A

according to her last menstrual period (LMP) not when she last had sex so she is 3 weeks pregnant not 2 weeks.

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7
Q

What is term pregnancy?

A

37 to 42 weeks

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8
Q

first trimester?

A

upto 12 weeks
-miscarriages are high in this stage

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9
Q

second trimester?

A

12-28weeks

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10
Q

third trimester?

A

28/37-41

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11
Q

The trend in medical and surgical method over the years

A

surgical method declined around 2014 and medical method increased
surgical = increased surgical risks, after-care
=>more ‘natural’
=>no surgery or anesthesia needed
=>precieved to be less frightening
=>more privacy
=>shorter stay in hospital
=>simpler and faster

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12
Q

what medical abortion is appropriate for gestation under 9 weeks?

A

=> Mifepristone 200mg PO :
-competes with progesterone receptors
-progesterone receptors are where the villi of the placenta are intact if there is disconnection of the receptors, the placenta is separate, placenta is separate so fetus can’t develop
-24-36 hrs later give: MISOPROSTOL 800mcg PV
=> Misoprostol is a prostaglandin (which make uterus contract and cervix dialate)
=> so Mifepristone to separate placenta and Misoprostol to contract uterus

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13
Q

Suction termination

A

-in the past it was seen to be avoided before 7 weeks now done anytime upto 14 weeks
-cervical prep beneficial (dialating cervix by softening using prostaglandins) prior to suction termination
-safer under local anaesthesia than manual vacuum aspiration (MVA)

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14
Q

What are some immediate complications during termination?

A

-anesthetic
-uteriene perforation- 0.8/1000
-cervical tears
- primary haemorrhage
-uteriene rupture
-death - rare 0.6/1,000,000

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15
Q

What are complications after discharge during termination?

A

rare:
-retained products of conception ~1: 100
-secondary haemorrhage
-pelvic infection
-failed abortion
-ectopic pregnancy

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16
Q

Prevention of STIs

A

-screen all women - opt out policy
-chlamydia, gonorrhea, syphilis, HIV
-treat positives and contact tracing to screena dn treat partners of they too are infected
-this will help with impact on their health and future fertility

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17
Q

What are late complications during termination?

A

-tubal factor infertility
-screening and antibiotics - prevention
-rhesus iso-immunisation blood group and antiD administration
-psychological and psychosexual sequelae
-counselling support and options to patients

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18
Q

psychological sequalae

A

-regret and early distress
-continuation of problems present before abortion
-long term post abortion distress risk factors :
unsupportive partner
ambivalence before abortion
prior psychiatric history
considering abortion is wrong

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19
Q

Aftercare of induced abortion

A

-anti-D prophylaxis
-written information
-contact details for support
-STI services follow up
-contraception advice and provision
-follow up appointment within 2 weeks optional

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20
Q

Long acting reversible contraceptive (LARC)

A

-7% of women switched to LARC according to NICE guidelines
-method: IUD, IUS, hormonal injection
-NHS save £100 million through reducing unintended pregnancies by 73,000
£26.8m new funding for improved access to contraception declared by the public health minister

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21
Q

Doctors good medical practise:

A

-treatment must be based on clinical judgement of patients needs and the likely effectiveness of the treatment
-you must not allow views about patients lifestyle, culture, beliefs, race, colour, gender, sexuality, disability, age or social/economic status to prejudice treatment
-must not refuse or delay treatment because you believe the patients actions have contributed to their condition

22
Q

legislation-1967/1990

A

=>1967; abortion act passed, introduced by David Steel in England, Wales and Scotland and came into effect in 1968
=>1990 ; human fertilisation and embryology Bill lowered the gestation limit for abortions from 28 weeks to 24 weeks(this is currently the viable age for fetus to survive outside mother’s womb.

23
Q

Northern Ireland -2017

A

funding scheme introduced to provide funded abortions in England and Wales, for residents of Northern Ireland.
travel was also funded by government equalities office and HM treasury

24
Q

2018 -misoprostol at home

A

-woman in Wales and England could take the 2nd pill (misoprostol) at home.
-This brought England and Wales in line with Scotland which allowed this from oct 2017 (lack of hospital links in rural area)

25
Q

December 2018- Northern Ireland

A

-abortion legalised on certain grounds, in the Irish Republic, up to 12 weeks gestation and later if the woman’s life or health at risk.

26
Q

2019-Northern Ireland

A

Abortion in Northern Ireland
decriminalised after a free vote by
Westminster MPs in July 2019.
The suspended Northern Ireland Executive
did not return by 21 October 2019,
meaning the amendment introduced by
Stella Creasy was passed into law
through The Northern Ireland (Executive
Formation etc) Act 2019 on 22 October
2019.

27
Q

2020 - Covid-19 -pills at home temporarily

A

Women in England and Wales can take both
abortion medications, mifepristone and
misoprostol, at home, without the need to
first attend a hospital or clinic. This has been
temporarily approved by the Secretary of
State for Health and Social Care to limit the
transmission of coronavirus (COVID-19)
from 30 March 2020 and by the Welsh
government’s Minister for Health and Social
Services from 31 March 2020

28
Q

2020 - Northern Ireland -31 March 2020

A

The Abortion (Northern Ireland)
Regulations 2020 came into force on 31
March 2020. The regulations introduce
a new legal framework for abortion
services in Northern Ireland.

29
Q

2022 - temporary to permanent

A
  • wales - 24 feb 2022 - temp => permanent taking both pills
    -England and Wales - 30 March 2022 - Health and care bills amendment - temp => permanent
30
Q

trend in abortion after covid-19

A

-214, 250 abortions for women resident in England and Wales - the highest since abortion act introduced in 1990s
-from 2016 there has been a constant increase in abortion trends, this coincides with the new rules and laws.

31
Q

Define reasons for termination

A

Group A -F

32
Q

Group A

A

Group A - the risk of continuance of pregnancy would involve risk to the life of pregnant woman greater than if the pregnancy were terminated.

33
Q

Group B

A

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

34
Q

Group C

A

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

35
Q

Group D

A

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.

36
Q

Group E

A

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.

37
Q

Group F

A

To save the life of the pregnant woman

38
Q

Public opinion supports abortion when a pregnancy is unwanted …

A

IPSOS MORI poll commissioned by bpas in 2006 tested support for statement; ‘if a woman wants an abortion she should not have to continue with her pregnancy
62% agree or strongly agree.

39
Q

Abortion care providers - private, NHS funded hospital, NHS funded hospital sector.

A

NHS funded hospital sectors and private sectors were high in the late 1900s but over time NHS funded independent sectors increases in the early 2000s and this resulted in a decrease in private sectors.

40
Q

Feticide

A

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

41
Q

Complications

A

278 cases in 2012, a rate of about one in
every 700 abortions, the same as in 2011
and
41 per cent lower than in 2002
There were no deaths following abortion
reported in

42
Q

Selective termination

A

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 one
fetus.

43
Q

Safeguard children act April 2006

A

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

44
Q

Late abortion found in younger women

A

1-1.6% abortion late (20+ weeks)
2.3% of all late abortion in women under 20
1.4% in women 30-39

45
Q

Reasons for seeking abortion late

A

-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

46
Q

The Chief Medical Officer’s key
recommendations

A

– the development of a best practice protocol the development of a best practice protocol
– commissioning of a review by the Department of commissioning of a review by the Department of
Health of access to abortion services including Health of access to abortion services including
support and counselling for women support and counselling for women
– service providers should review staff training needs service providers should review staff training needs
– staff involved in commissioning services should be staff involved in commissioning services should be
familiarised with the abortion law familiarised with the abortion law
– healthcare providers should identify sources of delay healthcare providers should identify sources of delay to make sure all abortions are carried out as early as to make sure all abortions are carried out as early as possible in line with agreed performance indicators possible in line with agreed performance indicator

47
Q

fetal sentience (ability to move and feel)

A

-between 12 and 40 weeks phenomenal changes occur
-fetus is sensitive to touch from 7 weeks and can move its limbs
-spinal reflex responses not brain activity dependent so unlikely to be conscious
-after 24 week start conscious movement

48
Q

perception of pain

A

anatomical structures for pain are in place by 26 weeks,
-feelings and emotions come from repetitive experiences and not directly from brain
-4D images used for smiling and crying, still debatable

49
Q

baby survival rate in the past and now and should we lower max age for abortion?

A

-24weeks :47% survived after being admitted to neo-natal units - some would have died on labour ward compared to 35% survival rate in 1995
-but those born at 23 weeks the increase from 19% to 26% not very significant
so even a week can affect the survival rate so much so should we lower maximum age for abortion?

50
Q

long term disabaility and pregnancy age

A

23 weeks = 67%
24 weeks = 38%
25 weeks =20%
so aborting later you are losing a perfectly normal baby

51
Q

Laws protecting woman >fetus

A

-English common law and under human rights act 1998 fetus is not legal person and its interest cannot be placed before the pregnant woman
-general principles guiding medical law in Britian is respect for autonomy of the patient

reproduction (29 decks)

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