Unplanned pregnancy Flashcards
what is the mid-cycle pregnancy risk following UPSI
30 percent
What are the indications for EC
UPSI Barrier failure Missed pills Late injection expelled IUD
What are the three available emergency contraception methods in the UK
Levonelle
ellaOne
IUD
How long can levonelle be taken after UPSI
72hrs
How long can ellaone be taken after UPSI
120hrs
what is the main componenet of levonell
levonorgestrel
what is the main component of ellaONe
ulipristal acetate
by what method do levonelle and ellaone work
inhibit ovulation
What are the other main differences between ellaone and levonelle
levonelle become less effective over time but ellaone does not
Levonelle is cheaper
what cautions should be taken with levonelle
enzyme inducers eg carbamazepine
increased BMI
what precautions should be taken with ellaone
antacids
How does the IUD work as EC
toxic to sperm/ovum
anti-implantation
when can IUD be inserted for eC
up to 120hrs post UPSI
up to five days after earliest expected date of ovulation
what is important to consider when inserting an IUD
can be retained for ongoing contraception
screen and treat for STI prior to insertion
in what age group are tops highest
20-24 yrs
What are the main methods of termination
Medical - early, late or mid trimester
Surgical - vacuum aspiration, dilatation and evacuation (note latter not available in Scotland)
When is an early medical abortion
before nineweeks
How is an early medical abortion carried out
- oral mifepristone 200mg (antiprogesterone)
- 24-48hrs later - vaginal or oral prostaglandin eg misoprostol, gemeprost
Second part may be carried out at home
When is a late medical abortion and how is it different from an early one
9-12wks
Repeates doses of prostaglandin 3 hourly (Max/24 hrs)
Note mid trimester terminations is the same method as late
When is a mid trimester termination
12-24wks
When is a vacuum aspiration carried out vs a dilatation and evacuation
Vacuum- 6-13wks
dilatation- 13-24 wks - not performed in scotland
up to what gestation is a medical top carried out in ninewells
18+6 wks
what is the method of surgical top
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
what are the risks of serious complications following top
1-2 in 1000
what are the possible complications
Pain Bleeding Infection Incomplete/failed procedure Uterine perforation* Cervical trauma* Psychological future reproductive outcome
What is the important aftercare following a TOP
UPT at 2-3 wks
CONTRACEPTION- given on site
