Unplanned Pregnancy

Question 1

what is the Abortion Act used in scotland?

Answer 1

Abortion Act 1967

Question 2

What are is the gestational limit for clause C?

Answer 2

24 weeks

Question 3

“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?

Answer 3

Clause C

Question 4

What is the gestational limit to clause E?

Answer 4

No gestational limit

Question 5

“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?

Answer 5

Clause E

Question 6

what is the conscientious objection (CO)?

Answer 6

Clause within 1967 Abortion Act allows HPCs (healthcare proxys) the right to refuse to participate in abortion care

Question 7

what are the limits of a conscientious objection (CO)?

Answer 7

-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

Question 8

what is done in the pre abortion consultation?

Answer 8

• 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

Question 9

what are the 2 medications that can be used for abortion?

Answer 9

-Mifepristone
-Misoprostol

Question 10

what is the limit of mifepristone?

Answer 10

11 weeks + 6 days

Question 11

can you take mifepristone at home?

Answer 11

yes

Question 12

what surgical abortions are available up 13 weeks + 6 days?

Answer 12

Electric vaccum aspiration (GA)
Manual vaccum aspiration
-can be done in scotland

Question 13

what surgical abortions are available > 14 weeks?

Answer 13

cervical dilatation and evacuation using forceps
-required travel to specialist in england

Question 14

what antibiotic is used for prophylaxis of post abortion sepsis?

Answer 14

7 days 100mg Doxycycline

Question 15

what is given to resus D engtive blood group women who are getting an abortion?

Answer 15

rhesus iso-immunisation
-Anti D Ig

Question 16

why is rhesis iso immunization given to rhesus D negative blood group women getting an abortion?

Answer 16

-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

Question 17

what is given to patients getting an abortion with a high risk of VTE?

Answer 17

LMWH for high risk after the abortion
LMWH for very high risk before abortion +/- continuing for longer

Question 18

what is the follow up after a hospital abortion?

Answer 18

-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

Question 19

what is the follow up after an early medical abortion at home?

Answer 19

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%)

Question 20

what are complications of abortion?

Answer 20

-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)

Question 21

what is the clinical assessment of gestation?

Answer 21

-Estimates by LMP +/- date of +ve UPT
-Palpable uterus (>12 weeks)

Question 22

what is the USS assessment of gestation?

Answer 22

-abdominal or transvaginal (<6 weeks)

Question 23

Treatment for abortion up to 12 weeks?

Answer 23

Oral Mifepristone followed by vaginal Misoprostol 48 hours later

miFepristone= First

Question 24

Role of mifepristone

Answer 24

inhibits Progesterone - causes termination of pregnancy

Question 25

Role of misoprostol

Answer 25

causes contractions of myometrium