Unplanned Pregnancy

Question 1

What are the indications for emergency contraception?

Answer 1

UPSI, barrier failuer, missed pills, late injection ,expelled IUD?

Question 2

Where is emergency contraception provided?

Answer 2

Pharmacy, GP, SRH clinic, A&E

Question 3

What are the 3 methods of emergency contraception currently available in UK?

Answer 3

Levonelle
ellaOne
Copper IUD

Question 4

When can Levonelle be used and what does it contain?

Answer 4

Up to 72hrs post UPSI (large dose progestrgen)

Question 5

What can ellaOne be used?

Answer 5

up to 120hrs post UPSI (ulipristal acetate)

Question 6

What are cautions for levonelle?

Answer 6

Enzyme inducer drugs (antiretrovirals, antiepileptic)

Question 7

What are the cautions for ellaOne?

Answer 7

Antacids

Question 8

When can the copper coil be used?

Answer 8

Up to 120hrs post-UPSI

Up to 5 days after earliest expected date of ovulation

Question 9

What is the mode of action of the copper coil

Answer 9

Toxic to sperm/ovum, anti-implantation

Question 10

What history is required during an emergency contraception consultation?

Answer 10

UPSI-date/time, previous episodes, previous EC
Menstrual cycle- LMP, length
PMH/DH- Any contraindications to use
Contraception use
STI risk assessment and screening

Question 11

What does the UK Abortion Act 1967 state?

Answer 11

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

Question 12

What are the grounds for termination (5)

In reality there are 7

Answer 12

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

Question 13

What needs to be covered in the initial termination of pregnancy consultation?

Answer 13

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

Question 14

When can a medical TOP be performed?

Answer 14

Up to 24 weeks

Question 15

What types of surgical TOP can be performed and when?

Answer 15

Vacuum aspiration 6-13 weeks

Dilatation and evacuation 13-24 weeks

Question 16

What drugs are used in an Medical TOP?

Answer 16

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

Question 17

What does vacuum aspiration involve?

Answer 17

Cervical priming with vaginal prostaglandin
Daycase, GA
(LARC fitting)

Question 18

What are the complications of TOP?

Answer 18

Pain
bleeding
infection
incomplete/failed procedure
Uterine perforation
cervical trauma
psychological effects
future reproductive outcome