TOPs Flashcards

1
Q

What regulation controls abortion in Ireland?

A

Regulated by the Health (Regulation of Termination of Pregnancy) Act 2018

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2
Q

When is abortion permitted in Ireland?

A

Abortion is permitted during the first twelve weeks of pregnancy, and later in cases where the pregnant woman’s life or health is at risk, or in cases of a fatal foetal abnormality.

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3
Q

What were the historical laws on abortion in Ireland?

A

Sections 58 & 59 of The Offences against the Person Act 1861 - abortion was illegal in Ireland and punishable with life imprisonment.

Protection of Life During Pregnancy Act 2013 - Destruction of unborn human life punishable by up to 14 years imprisonment

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4
Q

What did the eighth amendment 1983 state?

A

The Eighth amendment of the Constitution Act 1983 - Equal right to life of the mother and the unborn

67% to 33% in favour of the amendment in Sept 1983

Allowed abortion in circumstances where the life of a pregnant woman was at serious risk

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5
Q

What did the 13th and 14th amendments state?

A

Case X Nov 1992
Shall not limit freedom to travel between states
Shall not limit freedom to obtain or make available information relating to services lawfully available in another state
25th Amendment - in the case of risk of suicide was narrowly defeated 50.4% to 49.6% (2002)

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6
Q

What did the 36th amendment state?

A

25th May 2018 – Referendum leading to a repeal of the eighth amendment
Permits the Oireachtas to legislate for abortion
Yes ✔ 66.4 %
No ✗ 33.6 %
Signed into law 18th September 2018

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7
Q

What became law on 1st January 2019?

A

The Health (Regulation of Termination of Pregnancy) Act 2018 allows for a termination of pregnancy under 4 sections:

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8
Q

What does section 9 allow for?

A

Serious risk to life of or serious harm to health of a pregnant woman ( after examination by 2 medical practitioners – 1 obstetrician and one appropriate medical practitioner)
“Reasonable opinion formed in good faith”
Foetus must not have reached viability
Appropriate to carry out the termination in order to avert the risk to the pregnant woman

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9
Q

What does section 10 allow for?

A

In cases of emergency where there is an immediate serious risk to the life of or serious harm to the health of a pregnant woman, after examination by one medical practitioner.
Risk is immediate
Certification to happen before termination or within 3 days

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10
Q

What does section 11 allow for?

A

Where 2 medical practitioners are of the opinion formed in good faith that there is present a condition affecting the foetus that is likely to lead to the death of the foetus either before or within 28 days of birth.

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11
Q

What does section 12 allow for?

A

Where there has been a certification that the pregnancy has not exceeded 12 weeks and after a period of 3 days after this certification.
1 medical practitioner to certify “reasonable opinion performed in good faith”

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12
Q

Can a 16 or 17 year old consent to abortion?

A

encourage to involve parent or another supportive adult but can choose not to involve an adult. Doctor has to be confident that the information is understood and the individual is capable of giving valid consent.

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13
Q

At what ages does a doctor need to report to Tulsa?

A

14 years or under have engaged in sexual activity
15 or 16 years engaging in sexual activity with someone at least 2 years older
17 and under if the doctor suspects that there is risk of sexual abuse or harm

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14
Q

What offers information for women wishing to undergo a TOP?

A

My Options – HSE unplanned pregnancy support service – confidential freephone line and support services.

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15
Q

How is the 1st presentation of a woman planning an abortion dealt with?

A

When a woman attends the GP or hospital requesting an abortion, she is counselled by the doctor and is given a mandatory 3 day waiting period before embarking upon treatment.
The woman returns after minimum of 3 days and consent is signed.

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16
Q

What needs to be done by way of history, examination and ultrasound in a woman requesting a TOP?

A

The GP will decide if and ultrasound examination is required.
History and advice about STIs (sexually transmitted diseases) is performed and swabs performed if needed.
Certification that the pregnancy is less than 12 weeks is performed.

17
Q

What are the options for method of abortion at less than 12 weeks gestation?

A
  • medical managment
  • surgical management
18
Q

What is involved in medical management of abortion at less than 12 weeks?

A

Medical Management – mifepristone 200mg P.O. 24 – 48 hours before the administration of misoprostol 400mcg buccally (dissolved in the mouth).

Repeat the dose if needed in 4-6 hours. If > 9+6 weeks, must occur in hospital.

Pain relief is prescribed ( ibuprofen and paracetamol).

19
Q

What is involved in the surgical management of an abortion at less than 12 weeks?

A

Mifepristone 200mg 24-48 hours before surgical evacuation of the uterus (dilatation and suction / curettage).

Misoprostol 400mcg buccally or P.V. (per vagina) is given 2 hours before the procedure to prime the cervix and reduce the risk of perforation of the uterus on dilatation.

20
Q

How are GPs handling abortions?

A

GPs are now working in line with NICE Guidance of not offering Anti D prophylaxis to women having a medical abortion up to and including 10+0 weeks gestation.

GPs in Galway are doing TOP up to 9+6 weeks gestation.

The abortions performed by GPs up to 9+6 weeks are medical managed abortions

21
Q

What post abortion service is offered?

A

Women are counselled and offer follow up

Contraception should be discussed

Women are advised to take a home pregnancy test in 2 weeks. If the test remains positive, they are advised to contact the service provider

Women are advised to return in the event of potential complications

22
Q

What are potential complications of abortion?

A
  • Retained tissue and bleeding
  • Infection
  • Failed abortion and continuing pregnancy. If diagnosed failed abortion beyond 12 weeks, the pregnancy can no longer be terminated
  • Uterine perforation ( applies to surgical abortions)
  • Long term psychological impact – post abortion counselling is offered.