TOP Flashcards
What percentage of pregnancies are unplanned?
30-50%
What percentage of unplanned pregnancies end in abortion?
30-40%
In countries where proportion of abortions that are unsafe is much higher in countries where laws are more restrictive. Unsafe abortion accounts for 8 deaths per hour. True/false?
True
What act permits abortion in Scotland, England and Wales?
Abortion Act 1967 - did not legalise abortion but made it not an offence
Abortion (Northern Ireland) (No.2) Regulations 2020 allows abortion up to when?
available up to 11weeks & 6 days, beyond 12 weeks lawful in specific circumstances or in foetal abnormality
Form HSA1 AKA Certificate A must be signed by how many doctors for an abortion to be carried out?
2 doctors
What are the 2 emergency clauses and how many doctors can sign this?
Clauses F and G and only 1 doctor needs to sign if mothers life at risk
All abortions need to be reported to CMO via what form?
HSA4
What does Clause C of HSA1 form allow with regards to termination?
Termination up to 23wks + 6 days where continuing pregnancy would involve risk of injury to physical or mental health of pregnant woman
What does Clause E of the HSA1 form allow in regards to termination?
Allows termination at no gestational limit if there is substantial risk that if child were born it would suffer from such physical/mental abnormalities that would make it seriously handicapped
Conscientous objection does not apply in what situations?
does not apply in emergency or life-threatening situations, should not delay/prevent patient’s access to care and does not apply to indirect tasks associated with abortion e.g. administrative
What is patient journey prior to termination?
self-referral/referral, approx 5 days between referral and consultation, <2 weeks between consultation and procedure
Up to what day can early vacuum aspiration be carried out?
<49 days
Electric or manual vacuum aspiration with large-bore cannula can be carried out between what weeks?
wk 7-14
Dilatation and evacuation can be carried out between what weeks?
Wk 13 - 24
Medical abortion can be carried out at any point of gestation. This involves taking mifepristone and one dose of misoprostol. After how many days does this change to mifepristone and multiple doses of misoprostol?
After day 63 patient needs multiple doses
After how many weeks is surgical TOP only available through specialised service e.g. large bore cannula vacuum aspiration or dilatation and evacuation?
14 weeks
How long after mifepristone do you take misoprostol in TOP?
24-48hrs
What type of medication is mifepristone?
antiprogesterone
What type of medication is misoprostol?
prostaglandin to encourage uterus to expel
Prescribing mifepristone and misoprostol for home abortion is allowed up to what gestation?
11+6
Highest rate of termination is in which age group?
20-24 yrs
Assessing gestation stage is first step of TOP. How is this done?
Estimating by LMP +/- date of +ve UPT,
if uterus palpable they are >12 weeks,
USS: abdo or transvaginal (<6wks)
Since COVID most women no longer have an USS prior to TOP. What is the risk assessment carried out to determine whether patient should have scan?
symptoms or risk factors for ectopic, uncertainty about dates, before STOP (surgical) in some areas
What medications are given in medical abortion?
Mifepristone 200mg PO and Misoprostol 800mcg PV/SL 24-48hrs later
If not bleeding within _ hours of taking misoprostol, patients can take another dose.
4 hours
What are side effects of misoprostol?
diarrhoea, cramps, fever
Gestation > __ weeks undergoing medical TOP is an inpatient procedure. Patient is given mifepristone and returns to hospital as inpatient for misoprostol.
> 12 weeks
MTOP available up to how many weeks in Scotland?
19+6 weeks
What is fetocide and when may it be offered?
Potassium chloride administered into foetus heart guided by transabdo USS. Is administered from 20weeks prior to being given medical TOP.
The majority of TOP are early medical abortions at home. True/false?
True
What are the contents of EMAH pack?
mifepristone 200mcg + misoprostol 800mcg + additional 400mcg dose + anti-emetic + analgesia + antibiotics + contraception (6/12 POP) + pregnancy test
Cervical priming is carried out prior to surgical abortion. How is this done?
Using misoprostol or osmotic dilators
Vacuum aspiration is available at __ wks gestation, after this only dilatation and evacuation is available.
<14 weeks
Electric vacuum aspiration is done under LA and manual vacuum aspiration is done under GA. True/false?
False - electric under GA and manual under LA
Up to how many weeks gestation can manual vacuum aspiration be carried out?
up to 10wks
What antibiotic prophylaxis is given for abortion?
7-days 100mg doxycycline BD OR 1g oral azithromycin + 500mg daily for 2 days
Who receives antibiotic prophylaxis for abortion?
those undergoing STOP, those undergoing MTOP w/increased risk of STI
What are 5 complications of abortion, although rare?
Haemorrhage +/- blood transfusion, failed/incomplete abortion, infection, uterine perforation (STOP only), cervical trauma (STOP only)
Failed/incomplete abortion is slightly more common in MTOP or STOP?
MTOP though only 1%
Who receives anti-D Ig for abortions?
Prior to 10 weeks (even rhesus -ve women) no one is given anti-D Ig. After 10 weeks it is given to rhesus -ve women
What VTE prophylaxis is given for high-risk and very high-risk in abortion?
High risk: consider LMWH for 1/52 after abortion. Very high risk: consider starting LMWH before abortion +/- longer e.g. 6/52
