Unplanned Pregnancy Flashcards
What are the indications for emergency contraception?
UPSI, barrier failuer, missed pills, late injection ,expelled IUD?
Where is emergency contraception provided?
Pharmacy, GP, SRH clinic, A&E
What are the 3 methods of emergency contraception currently available in UK?
Levonelle
ellaOne
Copper IUD
When can Levonelle be used and what does it contain?
Up to 72hrs post UPSI (large dose progestrgen)
What can ellaOne be used?
up to 120hrs post UPSI (ulipristal acetate)
What are cautions for levonelle?
Enzyme inducer drugs (antiretrovirals, antiepileptic)
What are the cautions for ellaOne?
Antacids
When can the copper coil be used?
Up to 120hrs post-UPSI
Up to 5 days after earliest expected date of ovulation
What is the mode of action of the copper coil
Toxic to sperm/ovum, anti-implantation
What history is required during an emergency contraception consultation?
UPSI-date/time, previous episodes, previous EC Menstrual cycle- LMP, length PMH/DH- Any contraindications to use Contraception use STI risk assessment and screening
What does the UK Abortion Act 1967 state?
Termination must be performed by a registered medical practitioner
From opinion formed by 2 registered medical practitioners under 1 of the specified grounds
On licensed premises
Must be reported to the chief medical officer
What are the grounds for termination (5)
In reality there are 7
Risk to life of preganant women
Prevent injury to woman’s physical/mental health
Risk to health of existing children
Risk that child will be born with physical/mental abnormalities
Save pregnant woman’s life
What needs to be covered in the initial termination of pregnancy consultation?
Certainty/ discuss alternatives Ultrasound scan- confirm pregnancy and determine gestation Complete medical history Discuss methods Written consent Bloods (FBC/G+S/rubella/BBV) Counselling- ongoing contraception
When can a medical TOP be performed?
Up to 24 weeks
What types of surgical TOP can be performed and when?
Vacuum aspiration 6-13 weeks
Dilatation and evacuation 13-24 weeks
What drugs are used in an Medical TOP?
1) Oral mifepristone 200mg (anti-progesterone)
2) 24-48hrs later vaginal (or oral) prostaglandin e.g. misoprostol, gemeprost
Late/mid-trimester: Repeated doses of prostaglandins 3hrly (max 5/day)
Early (<9 weekly): Option to complete the 2nd part at home
What does vacuum aspiration involve?
Cervical priming with vaginal prostaglandin
Daycase, GA
(LARC fitting)
What are the complications of TOP?
Pain bleeding infection incomplete/failed procedure Uterine perforation cervical trauma psychological effects future reproductive outcome
