Unplanned Pregnancy Flashcards

1
Q

what abortion forms need filled out

A

HSAI - two doctors required to sign form

HSA2 - completed by doctor within 24 hours of emergency abortion

HSA4 - competed by a doctor and send to the chief medical officer within 7 days of the abortion taking place

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2
Q

what are the grounds for pregnancy termination

A

A- continuance of pregnancy would involve risk of life of pregnant woman

B- termination necessary to prevent grave permanent injury to physical/mental health of women

C- pregnancy has NOT exceeded its 24th week and continuance of pregnancy would involve risk of injury to physical or mental health of woman

D- pregnancy has not exceeded its 34th weeks and continuance would involve risk of injury to physical or mental health of existing children of pregnant woman

E- there is substantial risk that if the child were born it would suffer from physical or mental abnormalities as to be seriously handicapped

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

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

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3
Q

what is conscientious objection

A

doctors have right to ‘opt out’ of certain procedures because of personal beliefs/values

treatment in the event of an emergency may not be denied on grounds of conscientious objection

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4
Q

how long is an initial termination of pregnancy appointment and what is done

A

1 hour
certainty to proceed/discuss alternatives

ultrasound scan, confirm pregnancy, determine gestation

complete medical history

discuss methods available for TOP

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5
Q

what practicalities are done in a TOP consultation

A

Written consent for procedure and fatal remains

Bloods obtained

Optional screening for STI

Prophylactic antibiotics

Counselling re: ongoing contraception

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6
Q

what is the legal gestation limit for termination of pregnancy

A

23 weeks and 6 days

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7
Q

in NHS tayside what is the gestational limit for TOP i

A

surgical termination - up to 12 weeks

medical termination - up to 18 weeks and 6 days

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8
Q

how do you confirm gestation

A

clinically

  • estimated by last menstrual period
  • palpable uterus >12 weeks

ultrasound

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9
Q

what is medical aboriton

A

done <10 weeks gestation at home

if >10 weeks then its an inpatient procedure

2 pills
-mifepristone (anti progesterone)

-misoprostol (prostaglandin)
followed 24-48 hours after the mifepristone
(vaginal or oral)

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10
Q

how does medical termination of pregnancy change in those in late/mid trimester

A

repeated doses of prostaglandin 3 hourly (max 5/24 hours)

failed medical procedure may require surgical intervention

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11
Q

what is early medical abortion at home

A

woman comes in to take the mifepristone in the clinic (required by law)

woman then takes the misoprostal at home to prevent bleeding on the way home etc

only permitted for early terminations <10 weeks

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12
Q

what surgical termination options are there

A

<14 weeks
Electric vacuum aspiration

Manual vacuum aspiration

> 14 weeks
dilatation and evacuation

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13
Q

what is done before surgical termination

A

Cervical priming via misoprostal or osmotic dilators

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14
Q

what are the main complications of abortion

A

v low rates of morbidity and mortality

complications increase with increasing gestation

more complications with medical rather than surgical

pain - cramping is normal

bleeding - should be like a heavy period, may have light bleeding for up to 2 weeks after

infection

incomplete/failed procedure

uterine perforation

cervical trauma

anaesthetic complications

ongoing pregnancy

uterine rupture

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15
Q

what is done to decrease the risk of infection in abortion

A

prophylactic antibiotics for those undergoing surgical TOP and if they are at increased risk of an STI for medical TOP

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16
Q

what is done to protect a Rh -ve woman having an abortion

A

abortion is a sensitising event

should give anti D within 72 hours to prevent the development of anti D antibodies which can cross the placenta in future pregancies and destroy Rh+ fetal red blood cells

17
Q

what is done to reduce the risk of venous thrombosis embolism in woman who have had an abortion

A

is high risk start LMWH

18
Q

can contraception be started at the time of abortion

A

yes
almost all methods can be started at/soon after the abortion

they are effective immediately if started day of abortion

if stated after 5 days efficacy depends on method eg. CHC days 7 days to work

19
Q

when should intrauterine methods be avoided after an abortion

A

post-abortion sepsis

20
Q

what follow up is done after an abortion

A

after surgical abortion there is no need for follow up

after an in hospital medical abortion there is also no need for follow up

for those taking the second tablet at home, women are given a low sensitivity pregnancy test to be done at least 2 weeks after the abortion

signposting to support services