Unplanned Pregnancy Flashcards
5 main criteria for abortion?
A - continuance of pregnancy would involve risk to life of pregnant woman greater than if pregnancy were terminated
B - termination necessary to prevent grave permanent injury to physical/mental health of woman
C - pregnancy has not exceeded its 24th week and continuance of pregnancy would involve risk greater than if pregnancy were terminated of physical or mental health of woman
D - pregnancy has not exceeded its 24th week and continuance would involve risk greater than if pregnancy were terminated of injury to physical or mental health of existing children of women
E - there is substantial risk that if the child were born it would suffer from physical or mental abnormalities as to be seriously handicapped
how many doctors have to certify an abortion?
2
what forms must be completed to certify an abortion?
HSA1 (certificate A in Scotland)
- must be signed by 2 doctors
HSA2 (certificate B in scotland) - completed by doctor within 24 hrs of emergency abortion
HSA4 (completed by doctor and sent to chief medical officer within 7 days of abortion)
most common indications for abortion?
clause A (continuance of pregnancy involves risk to woman)
- limit of 24 weeks
2nd most common = cause E (risk that child will be born with significant physical or mental abnormalities as to be seriously handicapped)
- no gestational limit
what in conscientious objection?
allows doctors to refuse to participate in abortion care
- does not apply in emergency
- should not delay or prevent patient access to care
- does not apply to indirect involvement with abortion (admin etc)
referral and access to services targets?
present at GP or sexual health clinic, but can now self refer in some places
initial consultation at gynae or SHC within 5 days of referrral
procedure performed in gynae or SHC within 2 weeks of appointment
what takes place in consultation for TOP?
discuss certainty to proceed and alternatives
US scan - confirm IUP and determine gestation
blood tests - rhesus blood type
complete history
discuss methods of TOP
what else is done during TOP?
written consent bloods taken optional STI screen prophylactic antibiotics counselling (re - ongoing contraception etc)
gestation limits for abortion?
legal - social abortion = 23 weeks 6 days - fetal anomaly = any time NHS tayside - surgical termination = up to 12 weeks - medical = up to 18 weeks 6 days
how is gestation determined?
clinically - estimated by LMP +/- date of positive test - palpable uterus once over 12 weeks US - abdominal or transvaginal
what medications are used in medical abortion?
2 pill combination
- mifepristone 200mg (anti-progesterone)
- misoprostol (prostaglandin 800mg - given 24-48 hrs after)
how are the medications delivered in medical TOP?
sub-lingual or per vaginal
<10 weeks
- can self administer misoprostol at home
>10 weeks
- inpatient procedure
- repeated doses of PV misoprostol 800mcg PV then 400mcg 3 hourly PV/PO/SL (up to 4)
until which point in pregnancy can you have a medical TOP?
up to 19 weeks 6 days in scotland
early/late/mid-trimester classifications in medical TOP?
early = up to 9 weeks late = 9-12 weeks mid-trimester = 12-24 weeks
what is EMAH?
early medical abortion at home
early gestations under 10 weeks
misoprostol given to woman to be administered at home after 24-48 hours
would need to have good services in event of complications
