Unplanned Pregnancy Flashcards
what is the Abortion Act used in scotland?
Abortion Act 1967
What are is the gestational limit for clause C?
24 weeks
“Continuing the pregnancy would involve risk of injury to the physical or mental health of the pregnant women or her existing children/family (greater than if the pregnancy were terminated)”
Which Clause?
Clause C
What is the gestational limit to clause E?
No gestational limit
“There is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped”
which clause?
Clause E
what is the conscientious objection (CO)?
Clause within 1967 Abortion Act allows HPCs (healthcare proxys) the right to refuse to participate in abortion care
what are the limits of a conscientious objection (CO)?
-Does not apply in emergency or life threatening situations
-Should not delay or prevent a patients access to care
-Does not apply to ‘indirect’ tasks associated with abortions e.g. administrative, supervision of staff ect
what is done in the pre abortion consultation?
- Confirm ID and check alone/safe
- Feelings about pregnancy
- Assessment of gestation
- Gynae/obstetric history
- Medical, drug and social history
- Explore safeguarding issues e.g. under 16s, vulnerable groups
- Discussion of available options
- Risks of procedure and consent
- STI risk assessment +/- testing
- Contraception
*Further arrangements and follow-up
what are the 2 medications that can be used for abortion?
-Mifepristone
-Misoprostol
what is the limit of mifepristone?
11 weeks + 6 days
can you take mifepristone at home?
yes
what surgical abortions are available up 13 weeks + 6 days?
Electric vaccum aspiration (GA)
Manual vaccum aspiration
-can be done in scotland
what surgical abortions are available > 14 weeks?
cervical dilatation and evacuation using forceps
-required travel to specialist in england
what antibiotic is used for prophylaxis of post abortion sepsis?
7 days 100mg Doxycycline
what is given to resus D engtive blood group women who are getting an abortion?
rhesus iso-immunisation
-Anti D Ig
why is rhesis iso immunization given to rhesus D negative blood group women getting an abortion?
-Abortion may be ‘sensitising’ event where fetal blood cells can gin access to the maternal circulation
-this leads to development of anti D antibodies which can cross placenta in future pregnancies and destroy Rh +ve fetal red cells
what is given to patients getting an abortion with a high risk of VTE?
LMWH for high risk after the abortion
LMWH for very high risk before abortion +/- continuing for longer
what is the follow up after a hospital abortion?
-Routine clinical review (no USS required)
-No formal follow up after surgical abortion or in hospital medical abortion where passage of products of conception is confirmed
what is the follow up after an early medical abortion at home?
Low-sensitivity UPT performed at least 2 weeks after abortion (not standard UPT!) (cut off equivalent to 1000 iu/L HCG, “usual” UPT 25 iu/L)
To identify incomplete or failed procedure (<5%)
what are complications of abortion?
-Continuing pregnancy
-Need for further intervention to complete the procedure
-Infection
-Severe Bleeding requiring tranfusion
-Cervical injury from dilation and manipulation (surgical)
-Uterine perforation (surgical)
-Uterine rupture (surgical)
what is the clinical assessment of gestation?
-Estimates by LMP +/- date of +ve UPT
-Palpable uterus (>12 weeks)
what is the USS assessment of gestation?
-abdominal or transvaginal (<6 weeks)
Treatment for abortion up to 12 weeks?
Oral Mifepristone followed by vaginal Misoprostol 48 hours later
miFepristone= First
Role of mifepristone
inhibits Progesterone - causes termination of pregnancy
Role of misoprostol
causes contractions of myometrium
