Theme C Flashcards
Features of Abortion Act
Abortion Act 1967
2 medical professionals (need to sign HSA1)
Pregnancy < 24 weeks
- continuing the pregnancy is a greater risk than termination and injury to mental or physical health to her or any other children OR
- prevent grave permanent injury to physical or mental health OR
- risk life of pregnant woman OR
- substantial risk if the child is prn would suffer from abnormalities that would causes serious handicap
There is no upper limit on gestation if due to 2,3, or 4
What form is required for abortion?
HSA1
When can termination be granted in under 16s
Without parental consent if:
- understand all aspects and implications
- cannot persuade them to tell parents
- physical or mental health with suffer if they don’t
- best interests to receive without parental consent
What should happen before a termination?
Confirm pregnancy Discuss methods and choices available Consider alternatives Allow time for decision (but earlier has less complications) Screen for chlamydia and STIs (positive in 13%) Discuss future contraception Check Rh status Check if requires smear
Describe conscientious objection of abortion
Section 4 of Abortion Act Can refuse Must provide treatment necessary to save a life Must explain the objection Cannot express disapproval
Epidemiology of Down’s syndrome
1 in 1500 at 20 years
1 in 100 at 40 years
>1 in 50 at 45 years
Screening methods for Down’s syndrome
Serum screening - 10 to 14 weeks
Ultrasound - nuchal translucency - 11 weeks to 14 weeks
Quadruple test - 14 to 20 weeks
Once a test has been performed, the chance of the foetus having Down’s is calculated
If > 1 in 150 then offer diagnostic testing
- Amniocentesis - 12 to 18 weeks (most common after 15 weeks)
- Chorionic villus sampling - 11 to 13 weeks
Who provides antenatal care?
If uncomplicated - midwife and GP led
Small group of medical professionals
Women should carry their own case notes
10 visits - uncomplicated nulliparous
7 visits - uncomplicated multiparous
What do the outcomes framework monitor in relation to pregnancy?
Infant mortality (up to 1 year) Perinatal mortality (including still births), pregnancy, immediately after birth
Define fertility rate
births per 1000 women per year aged 15-44
Define number of conceptions
total maternities + legal abortions + admissions for miscarriage + ectopic pregnancy
- 75% are live or still births
- 18% legal termination
- 7% miscarriage or ectopic
Define maternity
Any pregnancy that results in birth of live or still born child
Define live birth
Complete expulsion of product of concetion from mother, regardless of duration which shows any signs of life
- HR, breathing, umbilical cord pulsation, movement
Define abortion
Complete expulsion of foetus showing no signs of life prior to 24 weeks gestation
Triennial report - types of maternal mortality
Direct - death from obstetric complications
Indirect - resulting from previous existing disease, aggravated by pregnancy
Fortuitous - incidental but during pregnancy
Define maternal mortality
Deaths per number of maternities
Most common causes of maternal mortality
Hypertensive disease PE Haemorrhage Amniotic fluid embolus Early pregnancy Sepsis Anaesthesia
Define perinatal mortality
Deaths occurring during the first 7 days of life and still births per 1000 births
8 per 1000
Define neonatal mortality
Deaths during the first 28 days per 1000 births
Define infant death
Death within the first year of life
Causes of infant death
Low birth weight Prematurity <37 weeks Increased age of maternal mother (over 35, increased still birth) lethal or severe congenital malformation Infection SIDS Accident/trauma
Reasons for choosing home birth
Familiar, relaxing environment Wear own clothes, take shower, eat, drink, move freely Don't want medical intervention Cultrual or religious norms Hisotry of fast labour Lower cost
When is home birth not recommended
Diabetes HTN Epilepsy Past C-section prengnacy complication e.g. pre-eclampsia Breech or abnormal lie < 37 weeks or over 41 Multiple pregnahcy
Where can a woman give birth
ANY WOMAN CAN CHOOSE ANY BIRTH SETTING
- home, midwifery led, obstetric led