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Reproduction and Sexual Health > Unplanned Pregnancy > Flashcards

Unplanned Pregnancy Flashcards

1
Q

How many unplanned pregnancies occur yearly?

A

80 million

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2
Q

How many abortions occur every year?

A

50 million

NOTE: with 20 million being performed under unsafe and illegal circumstances

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3
Q

In relation to contraception, why may abortion be needed?

A
  • Failure.
  • Non-use.
  • Incorrect/Inconsistent use
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4
Q

Suggest non-contraceptive related reasons for abortion.

A
  • Rape, domestic abuse, trafficking.
  • Lack of knowledge, lack of motivation.
  • Lack of planning, mistaken belief.
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5
Q

What are the 3 options in an unplanned pregnancy?

A
  1. Continue with the pregnancy and keep the baby.
  2. End the pregnancy by having an abortion.
  3. Continue with the pregnancy and have the baby adopted.
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6
Q

TOP is the most commonly performed gynae procedure in the UK

A

TRUE

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7
Q

Who are the highest rates of TOP seen in?

A

20-24year age group

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8
Q

There is a link between ______-__________ and TOP

A

Social-deprivation

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9
Q

Abortion is a very unsafe procedure

A

FALSE - it is a very safe procedure

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10
Q

Where do most TOP’s take place in i) Scotland ii) England?

A

i) NHS hospitals

ii) 60% take place in the independent sector under NHS contract

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11
Q

HSAI (Certificate A in Scotland): Who must sign this?

A

2 doctors

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12
Q

HSA2 (Certificate B in Scotland): When is this completed? By who?

A

Completed by the doctor within 24 hours of an emergency abortion

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13
Q

HSA4: Who must this be completed by? Sent to? When?

A

Must be completed by the doctor and sent to the Chief Medical Officer (CMO) within 7 days of the abortion taking place.

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14
Q

Out of the 7 categories of grounds of TOP, which one is most common?

A

C

Pregnancy has not exceeded its 24th week and continue of pregnancy would involve risk, greater than if the pregnancy was terminated, of injury of physical or mental health of the pregnant woman

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15
Q

There are 2 options for emergency termination, what are these?

A

F - it is necessary to save the life of the woman

G - it is necessary to prevent grave permanent injury to the physical or mental health of the woman

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16
Q

If concerned about a young person and you think you need to take the issue to social services, you must inform them about this but don’t need their consent

A

TRUE

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17
Q

REVISE ‘Conscientious Objection’

A

Basically doctors being able to opt out of procedures because they don’t believe in it as long as the patient does not suffer as a consequence

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18
Q

From referral to treatment, this should last no longer than ___ weeks

A

2

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19
Q

What are the important practicalities to make note of when someone comes in for a TOP?

A
  • Written consent for procedure and foetal remains.
  • Bloods obtained (FBC/G+S +/- BBV).
  • Optional screening for STI.
  • Counselling re: ongoing contraception.
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20
Q

What is the legal limit for social termination of pregnancy?

A

23 weeks + 6 days

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21
Q

When can a foetal anomaly be performed?

A

Any gestation

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22
Q

What is the upper limit for TOP in NHS Tayside?

A

18 weeks + 6 days

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23
Q

When can surgical termination be carried out?

A

Up to 12 weeks

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24
Q

When can medical termination be carried out?

A

18 weeks + 6 days

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25
Q

So what if you’re >18+6 in Tayside?

A

Have to go to BPAS. Since there are no options for TOP at >20weeks in Scotland, the pt would have to go to London

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26
Q

Ideally, termination should take place within the first 3 weeks of presentation

A

TRUE

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27
Q

What are the groups of medial terminations (in terms of timings)?

A

Early – up to 9 weeks.
Late – 9-12 weeks.
Mid-trimester – 12-24 weeks.

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28
Q

Medical termination is a 2 stage process (3 if incl. initial consultation). Outline this.

A
  1. Oral MIFEPRISTONE 200mg (anti-progesterone, RU486).

2. Vaginal (or oral) PROSTAGLANDIN 24-48hours later e.g. Misoprostol, gemeprost.

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29
Q

If the termination is early (<9weeks), what is there the option to do?

A

Complete the 2nd part of the TOP at home (if live within 45min drive of hospital).

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30
Q

If the termination is early (<9weeks), what is there the option to do?

A

Complete the 2nd part of the TOP at home (if live within 45 min drive of hospital).

31
Q

Compared to early medical TOP, what is required for late/mid-trimester TOP?

A

Repeated doses of prostaglandin 3 hourly, for a max of 5/24hours.

32
Q

What may a failed medical procedure require?

A

Surgical intervention

33
Q

What are the 2 types of surgical termination? When can each of these be done?

A
  • Vacuum aspiration - 6-12 weeks. (in Tayside, but actually legal up to 16weeks)
  • Dilatation and evacuation - 13-24weeks (not available in Scotland).
34
Q

Before surgical TOP, what is done? How?

A

Cervical ‘priming’ – with vaginal prostaglandin

35
Q

Outline the procedure in surgical TOP.

A
  • Day case, GA, electric vacuum aspiration technique.
  • Routine USS NOT required.
  • Long Acting Reversible Contraception fitting can be carried out at this point too.
36
Q

What is MVA?

A

A newer alternative for early gestation TOP/RPOC.

37
Q

When can MVA be done?

A

Up to 9 weeks

38
Q

What type of anaesthetic is used in MVA?

A

Local anaesthetic

39
Q

What does MVA have a role in?

A

Resource-poor settings/developing countries

40
Q

What is the overall risk of serious complications in a TOP?

41
Q

List some procedural risks associated with TOP.

A 
Pain – like period pains/labour pain if late TOP
Haemorrhage (increases with gestation) 
Infection
Incomplete/failed procedure
Uterine perforation*  1to 4/1000 – more likely if previous c-section
Cervical trauma* 1 in 100
Anaesthetic complications
Ongoing pregnancy
Uterine rupture
  • surgical risks.
42
Q

What follow-up is required after a TOP?

A

Urine Pregnancy Test at 2-3weeks – low sensitivity, high beta HCG threshold

43
Q

What should ALWAYS be given after a TOP?

44
Q

What should ALWAYS be discussed after a TOP?

A

CONTRACEPTION !!!

45
Q

What forms of contraception can be started immediately?

A

Pills, injection, implant

46
Q

What does the insertion of an IUD after a TOP depend on?

A

Depends on bleeding pattern, confirmation of products etc

47
Q

When is emergency contraception used?

A

After unprotected sexual intercourse

48
Q

Following UPSI, what is the mid-cycle pregnancy risk?

49
Q

When is emergency contraception needed?

A
  • When contraception hasn’t been used.
  • When contraception hasn’t been used correctly.
  • Before new contraceptive method has had chance to become effective.
50
Q

If more than ___ COC is missed, emergency contraception is needed

51
Q

If patch/ring has been off/out MORE THAN ___ hours then emergency contraception should be used.

52
Q

If the implant is fitted when out-with the first 5 days of cycle, and UPSI within the first 7 days of use _________ _____________

A

Emergency contraception

53
Q

How long does the ‘fertile period’ tend to last?

A

6 days – 5 days (sperm) + 1 day (ovum).

54
Q

In relation to UPSI, when should EC be taken?

A

Up to 5 days after UPSI, or within 5 days of predicted date of ovulation

55
Q

What are the 3 methods of EC?

A

Intrauterine – copper IUD

Oral – LNG-EC or UPA-EC

56
Q

When can the LNG (levonelle) emergency contraceptive pill be used?

A

Up to 72 hours post-UPSI (but up to 96 hours off-licence).

57
Q

When can the UPA (ellaONE) emergency contraceptive pill be used?

A

120 post UPSI

58
Q

How does LNG-EC vs UPA-EC (EHC) work?

A

By delaying ovulation

59
Q

What interaction should you be aware of with LNG?

A

Enzyme inducer

60
Q

What interaction should you be aware of with UPA?

A

Enzyme-inducers/ongoing contraception

61
Q

If pt is on/has recently taken an enzyme inducer, what may be a more suitable method of EC than LNG/UPA?

A

The copper coil

62
Q

What is UPA-EC?

A

An anti-progesterone

63
Q

What is LNG-EC?

A

High dose progestogen.

64
Q

When do neither emergency contraceptions work?

A

After ovulation

65
Q

When can UPA-EC work?

A

During LH surge, but not after peak

66
Q

When does LNG-EC work?

A

Until just before LH surge

67
Q

When should you avoid UPA?

A
  • If wishing to “quick-start” hormonal contraception
  • Must delay ongoing contraception for 5 days
  • If hormonal contraception has been used in past 7 days
  • If patient has acute severe asthma uncontrolled by oral steroids
68
Q

Who should be offered the copper coil?

A

ALL eligible women requesting EC

69
Q

The copper coil is 10x’s more effective than emergency contraception

70
Q

When can insertion of the copper coil be done?

A
  • Up to 120 hours post-UPSI

* Up to 5 days after earliest expected date of ovulation

71
Q

What is the mode of action of the copper coil?

A
  • Pre- and post-fertilisation effects.

* Toxic to sperm/ovum, anti-implantation

72
Q

What should be screened for prior to insertion of the copper coil?

73
Q

When does implantation occur? When, therefore, can a Cu IUD be fitted?

A

A pregnancy doesn’t implant during the first 5 days post fertilization

  • 84% implant at 8-10 days post fertilization
  • Earliest likely is at 6 days
74
Q

A Cu IUD can be fitted UP TO 5 DAYS post-UPSI or 5days after likely ovulation

Reproduction and Sexual Health (51 decks)

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