Termination of Pregnancy

Question 1

List some common causes of unplanned pregnancy

Answer 1

Incorrect/failed contraception
Rape
Domestic abuse
Trafficking
Lack of knowledge/motivation
Lack of planning

Question 2

What is the most commonly performed gynaecological procedure in the UK?

Answer 2

Termination of pregnancy

Question 3

How many medical practitioners are required to sign off on an abortion under the 1967 act?

Answer 3

2

Question 4

Ground for non-emergency termination of pregnancy rank A-E. What is ground A?

Answer 4

Continuation of pregnancy would involve risk to pregnant woman greater than if pregnancy were terminated

Question 5

Ground for non-emergency termination of pregnancy rank A-E. What is ground B?

Answer 5

Termination if necessary to prevent grave, permanent injury to physical/mental state of woman

Question 6

Ground for non-emergency termination of pregnancy rank A-E. What is ground C?

Answer 6

Pregnancy has not exceed 24th week of gestation and continuation of pregnancy would involve risk of injury to physical/mental state of woman

Question 7

Ground for non-emergency termination of pregnancy rank A-E. What is ground D?

Answer 7

Pregnancy has not exceed 24th week of gestation and continuation of pregnancy would involve risk of injury to physical/mental state of existing children of pregnant woman

Question 8

Ground for non-emergency termination of pregnancy rank A-E. What is ground E?

Answer 8

Substantial risk that if child is born it will suffer from physical or mental abnormality and be seriously handicapped

Question 9

Ground for emergency termination of pregnancy rank F-G. What is ground F?

Answer 9

It was necessary to save the life of the woman

Question 10

Ground for non-emergency termination of pregnancy rank A-E. What is ground G?

Answer 10

It was necessary to prevent grave injury to the physical/mental state of the woman

Question 11

List some ethical factors that might come into play during termination of pregnancy

Answer 11

Under 16
Learning disability
HIV +ve
Patient confidentiality
Evidence of abuse

Question 12

Can a doctor opt out of termination of pregnancy?

Answer 12

Yes if he/she has conscientious objection due to personal/moral/religious beliefs

Question 13

What are some important points for a doctor to remember if objecting to performing a termination of pregnancy?

Answer 13

Avoid discrimination of patient
Ensure patient’s treatment is not delayed or denied
Prompt referral to colleague
Treatment must be given in emergency setting

Question 14

What is the legal limit for social termination of pregnancy? In NHS Tayside?

Answer 14

23 weeks 6 days (24 weeks)

18 weeks 6 days

Question 15

What is the legal limit for termination of pregnancy due to fetal anomaly?

Answer 15

Any point of gestation

Question 16

Medical termination can be given early, late or mid-trimester. What is the cut-off for each?

Answer 16

Early: up to 9 weeks
Late: 9-12 weeks
Mid-trimester: 12-24 weeks

Question 17

What are the 2 stages involved in medical termination of pregnancy?

Answer 17

Oral mifepristone (anti-progesterone)
Vaginal/oral prostaglandin 24-48hrs later

Question 18

If someone undergoes early medical termination (before 9 weeks), they can undergo the 2nd stage (prostaglandin) at home. True/False?

Answer 18

True

Need to do pregnancy test after 2-3 weeks to make sure though

Question 19

What surgical methods can be used to terminate a pregnancy?

Answer 19

Vacuum aspiration (6-12 weeks)
Dilation and evacuation (not used in Scotland)

Question 20

What are the indications for emergency contraception?

Answer 20

Unprotected sex
Missed pills
Late Depo injections
Expelled IUD/IUS

Question 21

What are the 3 methods of emergency contraception available?

Answer 21

Levonelle pill up to 72hrs post-UPSI
ellaOne pill up to 120hrs post-UPSI
IUD

Question 22

Which has the greater failure rate - Levonelle or ellaOne?

Answer 22

Levonelle

Question 23

What is the most common age group for termination of pregnancy?

Answer 23

20-24yo

Question 24

In what situation, may a doctor not have conscientious objection to TOP?

Answer 24

Treatment in event of an emergency

Question 25

What is discussed in an initial TOP consultation?

Answer 25

``` Alternatives to termination US scan Full medical history Suitable methods for TOP Bloods Prophylactic antibiotics Counselling for contraception ```

Question 26

List complications of TOP

Answer 26

``` Pain Haemorrhage Infection Incomplete/failed procedure Anaesthetic complications Uterine perforation (surgical) Cervical trauma (surgical) Uterine rupture ```

Question 27

What aftercare should be provided for the patient?

Answer 27

``` Urine pregnancy test at 2-3 weeks Risk of ongoing pregnancy AntiD within 72 hours When to seek help (contact information) Referral for SRH if indicated Contraception advice ```

Question 28

Which method of contraception should be avoided after a medical TOP?

Answer 28

DMPA (high progesterone) that could interact with medical termination (anti-progesterone)