Unplanned pregnancy

Question 1

what is the mid-cycle pregnancy risk following UPSI

Answer 1

30 percent

Question 2

What are the indications for EC

Answer 2

UPSI
Barrier failure 
Missed pills
Late injection
expelled IUD

Question 3

What are the three available emergency contraception methods in the UK

Answer 3

Levonelle
ellaOne
IUD

Question 4

How long can levonelle be taken after UPSI

Answer 4

72hrs

Question 5

How long can ellaone be taken after UPSI

Answer 5

120hrs

Question 6

what is the main componenet of levonell

Answer 6

levonorgestrel

Question 7

what is the main component of ellaONe

Answer 7

ulipristal acetate

Question 8

by what method do levonelle and ellaone work

Answer 8

inhibit ovulation

Question 9

What are the other main differences between ellaone and levonelle

Answer 9

levonelle become less effective over time but ellaone does not
Levonelle is cheaper

Question 10

what cautions should be taken with levonelle

Answer 10

enzyme inducers eg carbamazepine

increased BMI

Question 11

what precautions should be taken with ellaone

Answer 11

antacids

Question 12

How does the IUD work as EC

Answer 12

toxic to sperm/ovum

anti-implantation

Question 13

when can IUD be inserted for eC

Answer 13

up to 120hrs post UPSI

up to five days after earliest expected date of ovulation

Question 14

what is important to consider when inserting an IUD

Answer 14

can be retained for ongoing contraception

screen and treat for STI prior to insertion

Question 15

in what age group are tops highest

Answer 15

20-24 yrs

Question 16

What are the main methods of termination

Answer 16

Medical - early, late or mid trimester

Surgical - vacuum aspiration, dilatation and evacuation (note latter not available in Scotland)

Question 17

When is an early medical abortion

Answer 17

before nineweeks

Question 18

How is an early medical abortion carried out

Answer 18

1. oral mifepristone 200mg (antiprogesterone)
2. 24-48hrs later - vaginal or oral prostaglandin eg misoprostol, gemeprost

Second part may be carried out at home

Question 19

When is a late medical abortion and how is it different from an early one

Answer 19

9-12wks

Repeates doses of prostaglandin 3 hourly (Max/24 hrs)
Note mid trimester terminations is the same method as late

Question 20

When is a mid trimester termination

Answer 20

12-24wks

Question 21

When is a vacuum aspiration carried out vs a dilatation and evacuation

Answer 21

Vacuum- 6-13wks

dilatation- 13-24 wks - not performed in scotland

Question 22

up to what gestation is a medical top carried out in ninewells

Answer 22

18+6 wks

Question 23

what is the method of surgical top

Answer 23

Cervical priming - vaginal prostaglandin
Procedure- can be either daycase or GA
LARC may be fitted
USS not required

Manual vacuum aspirate can be performed under LA

Question 24

what are the risks of serious complications following top

Answer 24

1-2 in 1000

Question 25

what are the possible complications

Answer 25

Pain
Bleeding
Infection
Incomplete/failed procedure
Uterine perforation*
Cervical trauma*
Psychological
future reproductive outcome

Question 26

What is the important aftercare following a TOP

Answer 26

UPT at 2-3 wks

CONTRACEPTION- given on site