Unplanned Pregnancy Flashcards
what % of all pregnancies are unintended at conception?
30-50%
what is a HSA1 (certificate A) form and who is required to sign?
form stating the reasons for termination
2 doctors required to sign
*5 clauses - A to E
when would a HSA1 form be carried out?
in an emergency abortion - must be completed within 24 hours of emergency abortion
*clauses F&G
what is a HSA4 form?
notification for the CMO - must be completed by doctor and sent to chief medical officer within 7 days of abortion taking place
for the grounds of termination, what do the clauses A to E state?
A = continuance of pregnant involve risk of life to pregnant woman greater than if terminated B = termination necessary to prevent permanent injury to physical / mental health C = pregnancy hasn't exceeded 24 weeks and would involve risk to injury of physical or mental health or woman D = same as above but would involve risk to existing children E = there is risk that if child were born, it would suffer from physical or mental abnormalities as to be seriously handicapped
for the grounds of termination, what to clauses F and G state?
F = it was necessary to save life of woman G = it was necessary to prevent grave injury to physical or mental health of pregnant woman
under what clause are most terminations certified under?
clause C (98%) = pregnancy has not exceeded its 24th week and continuance of pregnancy would involve risk of injury to physical or mental health of pregnant women
*next common is E - no gestational limit
what are the limitations of conscientious objection (1967 abortion act allowing HCPs the right to refuse to participate in abortion care)?
does not apply in emergency or life-threatening situations
should not delay or prevent access to care
does not apply to “indirect” tasks associated with abortion (eg admin, supervision)
what is the waiting time between referral time by GP or SRH and the procedure?
<5 days between referral and consultation
<2 weeks between referral and procedure (in SRH or gynaecology)
how can gestation be assessed clinically?
estimated by LMP +/- date of positive UPT
palpable uterus - seen after 12 weeks (if no palpable uterus then probably in 1st trimester)
what is most commonly used to confirm gestation and what are the two types of this?
ultrasound
abdominal and transvaginal (<6 weeks)
what two medications are involved in a medical abortion?
mifepristone 200mg PO (anti-progesterone)
misoprostol 800mcg - 4 x 200mcg PV / SL (24-48 hours later)
medical abortions below which week gestation can be carried out at home?
<10 weeks
what is the difference in dose of misoprostol in medical abortions >10 weeks (inpatient)?
misoprostol: 800mcg PV then 400mcg 3 hourly PV / PO / SL (up to 4)
up to which gestation is medical termination available in Scotland?
19+6 weeks
> 20 weeks require travel to England
early medical abortion at home is not recommended for who?
those under 16
those with clotting disorders, likelihood of complications, support at home, distance from hospital
for a surgical abortion, what is used for cervical priming?
misoprostol or osmotic dilators
*this reduces complication rates
how can a surgical abortion <14 weeks carried out?
electric vacuum aspiration (under GA)
manual vacuum aspiration (under LA, up to 10 weeks only)
how is a surgical abortion >14 weeks carried out?
dilation and evacuation
surgical termination of pregnancy is not available >14 weeks in scotland - true or false?
true (usually not much past 12 weeks)
*would need to travel to specialist surgeons in England
abortion is a relatively safe procedure - true or false?
true
*complications generally increase with increasing gestation but still rare
what are the possible complications of abortion?
haemorrhage (severe bleeding requiring transfusion rare, higher in SToP)
failed / incomplete abortion (higher if mifepristone / misoprostol administered on same day)
infection (lowest for early)
uterine perforation (SToP only) = lower for early abortions
cervical trauma (SToP only) = lower for early abortions, reduced with cervical priming
who is given antibiotic prophylaxis at time of abortion?
those undergoing SToP
those undergoing MToP with increased risk of STI
what antibiotic prophylaxis is given at time of abortion?
doxycycline 100mg BD 7 days
or
azithromycin 1g + 500mg OD for 2 days
how can rhesus sensitising event be prevented?
by administration of anti-D Ig to at risk Rhesus -ve mothers
*if not given, can lead to development of anti-D antibodies which can cross placenta in future pregnancies and destroy Rh+ve foetal RBC
for those at risk of VTE, what prophylaxis can be given?
high risk = consider LMWH 1 week after abortion
very high risk = consider starting LMWH before abortion and continue longer
what type of contraception is recommended after abortion?
implant, copper coil and hormone coil
almost all methods of contraception can be started at / soon after abortion - when is it effective?
immediately if started on the day of abortion (or within 5 days)
if started after 5 days, efficacy depends on method
- POP (2 days)
- CHC / DMPA / SDI / LNG-IUS (7 days)
when is it not recommended to put a coil in?
endometriosis or sepsis post-abortion
women should avoid FAM (fertility awareness method) until when?
regular menstruation occurs
when can intra-uterine methods of contraception (LNG-IUS or Cu-IUD) be inserted?
immediately after SToP or MToP once expulsion of pregnancy is confirmed
when can hormonal methods of contraception (CHC, SDI, DMPA, POP) be used?
started any time after MToP or SToP including day of mifepristone / misoprostol
when can non-hormonal methods of contraception be used?
barrier methods can be used anytime (except diaphragm after 2nd trimester TOP)
sterilisation after some time has elapsed (risk of failure and regret)
avoid FAM until regular periods resume
what follow up should take place after early medical termination at home?
low sensitivity UTP performed at least 2 weeks after abortion (not standard UPT - these can show elevated hCG up to 4-6 weeks after procedure)
this is to identify incomplete or failed procedure
*if +ve then invited back for US - if some left can be managed conservatively or surgically
