unplanned pregnancy

Question 1

in the UK up to when can you get an abortion

Answer 1

24 weeks

Question 2

when does conscientious objection not apply

Answer 2

-not in emergencies or life threatening situations
-should not delay or prevent a patients access to care
-does not apply to indirect tasks associated with abortion

Question 3

what is the first part of medical abortion

Answer 3

mifepristone

Question 4

investigation for gestation

Answer 4

-clinical (LMP +/- date of +ve UPT)
-palpable uterus at 12 weeks
-ultrasound (abdo or transvaginal) at > 6 weeks

Question 5

who requires a USS before abortion

Answer 5

-symptoms or risk factors for ectopic
-uncertainty about dates
-before STOP in some areas

Question 6

what drugs for medical abortion

Answer 6

mifepristone
misoprostol 24-48 hours later

Question 7

when can women get a medical abortion

Answer 7

-up to 11+6 weeks gestation can do it at home
-12-23+6 weeks have to be inpatient

Question 8

when would you give a second dose of misoprostol

Answer 8

is expulsion not occurred within 4 hours

Question 9

what age can women take misoprostol

Answer 9

not recommended for under 16

Question 10

what is found in EMAH packs

Answer 10

-mifepristone
-misoprostol (2 doses)
-anti emetic
-analgesia
-antibiotics
-contraception

Question 11

complications

Answer 11

-infection
-bleeding requiring transfusion
-failed/incomplete abortion
-uterine perforation (surgical risk)
-cervica trauma (surgical risk)
-uterine rupture

Question 12

who gets antibiotic prophylaxis

Answer 12

-those undergoing STOP
-those undergoing MTOP with an increased risk of STI

Question 13

rhesus iso immunisation

Answer 13

• for women with a rhesus D negative blood group
  -leads to development of anti-D antibodies which can cross the placenta in future pregnancies and destroy Rh +ve fetal red cells

Question 14

VTE prophylaxis

Answer 14

if high risk then LMWH 1/12 weeks after abortion
if very high risk then consider starting LMWH before abortion too

Question 15

what is conscientious objection

Answer 15

clause within the 1967 abortion act allowing HCPs the right to refuse to participate in abortion care

Question 16

clause C and E for abortions

Answer 16

• Clause C - up to 23+6 weeks
  
  • 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
• Clause E - no gestational limit
  
  • There is substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped

Question 17

methods of surgical abortion

Answer 17

< 14 weeks electric (GA) or manual vaccum aspiration (LA), > 14 weeks dilation and evacuation

Question 18

what is the antibiotic prophylaxis

Answer 18

7 days doxycycline

Question 19

when can contraceptive be started again after abortion

Answer 19

almost immediately after