Unplanned pregnancy

Question 1

give the 3 options with an unplanned pregnancy

Answer 1

continue & keep
end with abortion
continue and have baby adopted

Question 2

give 4 aspects of the abortion act

-name the 3 abortion forms

Answer 2

2 registered medical practitioners are of the opinion that an abortion is justified
only a registered medical practitioner can terminate a pregnancy
must take place in NHS hospital or approved premises
Legal requirements apply to certification and notification of abortion procedure

-HSA1- signed by two doctors
HSA2- to be completed within 24 hrs of emergency abortion
HSA4- Must be completed by doctor and sent to the chief medical officer within 7 days

Question 3

conscientious objection

• what does this mean?
• must ensure what?

Answer 3

• doctors have a right to opt out of certain procedures because of personal beliefs/values provided
• that patients dignity and views must be respected and patient treatment cannot be denied or delayed
• may have to perform in an emergency however

Question 4

describe the process of a TOP consultation and follow up

Answer 4

secondary referral to nurse led TOP clinic

referral to treatment in 2 wks

initial consultation

• certainty to proceed & alternatives
• US to confirm IUP & gestation
• complete medical hx
• methods discussion
• written consent for procedure
• bloods obtained & optional screening done
• counselling

Question 5

gestation limits

• legal limit?
• Tayside limit?

Answer 5

-social termination (23 wks, 6 days)
foetal anomaly (any gestation)

-surgical termination up to 12 wks
medical termination up to 18 wks and 6 days

Question 6

methods of termination

• medical and surgical
• medical: up to what gestation? what medication is used?
• surgical: up to what gestation? describe process?

Answer 6

-early (9 wks)
late (9-12)
Mid trimester (12-24)

-2 stage process, oral Mifepristone 200mg (anti-progesterone)
24-48 hrs later give vaginal or oral prostaglandin (e.g. misoprostol, gemeprost)
late/mid trimester can repeat the doses of prostaglandin 3 hourly (max 5 in 24 hrs)
if fails then might need require surgical intervention

-vacuum aspiration (6-12 wks)
Dilatation & evacuation (13-24 wks)
cervical priming with vaginal prostaglandin
daycase-GA and vacuum aspiration

Question 7

complications of TOP

name the procedural risks of TOP?

Answer 7

pain
haemorrhage
infection
incomplete/failed procedure
uterine perforation/cervical trauma
anaesthetic complications
ongoing pregnancy
uterine rupture

Question 8

what does follow up of TOP involve?

Answer 8

preg test 2-3 wks after
risk of retained tissues
Anti D
counselling
CONTRACEPTION
sexual health referral

Question 9

name the 3 different methods of emergency contraception

Answer 9

Oral:
levonelle- up to 72 hrs post UPSI, inhibits ovulation but can’t be used with enzyme inducers

ellaOne- up to 120 hrs post UPSI, inhibits ovulation but can’t be used with antacids

IUD: copper IUD

Question 10

what info should be gathered during an emergency contraception consultation?

Answer 10

Hx
UPSI- date/time, prev episodes this cycle, previous EC?
Menstrual cycle-LMP, length
PMH/DH?
contraception
STI risk assessment