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
what is surgical abortion?
cervix is primed via misoprostol or osmotic dilators and PoC removed via surgical procedure and anaesthetic
surgical abortion under 14 weeks?
- electric vacuum aspiration (GA)
- manual vacuum aspiration (up to 10 weeks - LA)
surgical abortion over 14 weeks?
- dilation and evacuation
- cant do surgical abortion over 14 weeks in scotland
possible complications of abortion?
risk increased with increasing gestation but still rare
haemorrhage
pain
infection
failed/incomplete abortion
uterine perforation or cervical trauma (only in surgical)
any anaesthetic complications
normal side effects of abortion?
cramping
bleeding which will become like a heavy period but will then reduce when cramps reduce
may have light bleeding for up to 2 weeks
what prophylaxis is given at time of prophylaxis?
antibiotics given to everyone undergoing surgical abortion and anyone undergoing medical abortion who is at increased risk of STI (screening not done or dont have results)
- 7 days 100mg doxycycline???
- 200mg doxycycline given max 2hrs before abortion or 500mg azithromycin
Rheus iso-immunisation in people with rheus D negative blood type with surgical or mid-late medical abortion
VTE prophylaxis in people with risk factors
- LMWH or fragmin
rheus D negative blood group can cause anti D antibody development in abortion, what is this?
if the mother has rhesus negative blood and the baby has rhesus positive blood, after an abortion, the blood from the foetus can mix with the mother and cause an immune reaction
main contraindication for medical abortion?
severe asthma
how quickly does ovulation resume after abortion?
> 90% within the first month (as early as 8 days after early abortion)
contraception after abortion?
immediately effective if started day of abortion or within 5 days
(efficacy depends on method if started after 5 days)
long acting reversible contraception methods most recommended
when should the coil be avoided?
post abortion sepsis or infection
how are other hormonal methods used in abortion?
can be started any time after medical or surgical including the day of
how are non-hormonal contraception methods used after abortion?
anytime
- diaphragm not used immediately after 2nd trimester TOP)
sterilisation not done at time of abortion
abortion follow up?
no formal follow up after surgical abortion or in hospital medical abortion where passage of PoC is confirmed
after EMAH, low-sensitivity UPT (pregnancy test) performed at least 2 weeks after abortion
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