Unplanned Pregnancy Flashcards
what abortion forms need filled out
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
what are the grounds for pregnancy termination
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
what is conscientious objection
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
how long is an initial termination of pregnancy appointment and what is done
1 hour
certainty to proceed/discuss alternatives
ultrasound scan, confirm pregnancy, determine gestation
complete medical history
discuss methods available for TOP
what practicalities are done in a TOP consultation
Written consent for procedure and fatal remains
Bloods obtained
Optional screening for STI
Prophylactic antibiotics
Counselling re: ongoing contraception
what is the legal gestation limit for termination of pregnancy
23 weeks and 6 days
in NHS tayside what is the gestational limit for TOP i
surgical termination - up to 12 weeks
medical termination - up to 18 weeks and 6 days
how do you confirm gestation
clinically
- estimated by last menstrual period
- palpable uterus >12 weeks
ultrasound
what is medical aboriton
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)
how does medical termination of pregnancy change in those in late/mid trimester
repeated doses of prostaglandin 3 hourly (max 5/24 hours)
failed medical procedure may require surgical intervention
what is early medical abortion at home
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
what surgical termination options are there
<14 weeks
Electric vacuum aspiration
Manual vacuum aspiration
> 14 weeks
dilatation and evacuation
what is done before surgical termination
Cervical priming via misoprostal or osmotic dilators
what are the main complications of abortion
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
what is done to decrease the risk of infection in abortion
prophylactic antibiotics for those undergoing surgical TOP and if they are at increased risk of an STI for medical TOP
