Unplanned Pregnancy Flashcards
30-50% of pregnancies in the UK are “unintended”. What does this mean?
unplanned OR mistimed
What reasons are there for unintended pregnancies decreasing in more developed than developing areas?
Due to access to education on long acting contraceptives
If a pregnancy is unplanned then it can occur in poorer outcomes for the child. TRUE/FALSE?
TRUE
- this is often because pre-conception counselling cannot take place to encourage mothers to stop smoking/drinking etc
What percentage of unintended pregnancies undergo abortion?
30-40%
What percentage of abortions in lower income countries are considered “unsafe”?
~50% unsafe => present significant risk to mother
Are unsafe abortions more likely to occur in countries with lenient or strict laws on abortion?
Strict laws
What country has recently had legislation passed in order to be included in the Abortion Act?
Northern Ireland
Scotland, England and Wales already included
Explain who must sign the certificate of abortion in the UK
HSA1 form “Certificate A” - 2 Doctors must sign this
(Includes 5 clauses A-E for reason of abortion)
HSA2 form - includes Emergency Clauses - Signed by 2 Doctor when abortion is required to save mother’s life
Who must be informed when an abortion is carried out in the UK?
Regional Chief Medical Officer
What clause of the HSA1 “Certificate A” do most abortions come under in the UK?
Clause C (95% of abortions) - would cause mother significant physical/mental distress to continue with the pregnancy
1-2% of abortions come under another clause of the HSA1 “Certificate A”. Which clause is this?
Clause E
- termination due to genetic defects which will render the child physically/mentally unwell after birth
Clause E of the HSA1 Abortion Certificate has no gestational limit. What does this mean?
Clause E can be used to terminate a pregnancy at any point during gestation
What is “conscientious objection”?
- healthcare professional can decide that they dont wish to participate in abortion procedures/referrals
HOWEVER: - they have a duty to treat a patient in an emergency (e.g. if experiencing a PV haemorrhage)
- they must not delay care to patients e.g. pass on to a colleague for filing a referral etc
How many abortions procedures happen annually in the UK?
> 200,000
- it is the most common gynaecological procedure
Patients attending the abortion clinic are normally referred from where?
- GP
- sexual health clinic
How much time should be between the referral to abortion services and the eventual consultation?
Aim for <5 days
Where is the initial consultation regarding abortion held and how long between this and the eventual procedure?
- consultation in sexual health or gynaecological setting
- Aim for <2 weeks between consultation and procedure
There has been a large fall in abortion rates in the under 20 years age group. Why do we think this is?
- due to aimed promotion of long acting contraceptive methods
Are abortion rates higher in high or low socioeconomic areas?
2x higher abortion in lower income areas
Before what week of gestation do most abortions occur in Scotland?
< 9 weeks
What are the two main categories of abortion procedure in the UK?
Medical (tablets) vs Surgical
What does the choice of abortion procedure depend on?
- gestation at time of abortion
- preference
- regional availability
How can gestation be assessed to make a choice on abortion procedure?
Clinically:
- LMP and date of first positive pregnancy test
- Palpable uterus? (only present if >12 wks)
US Scan:
- abdominal or transvaginal
Describe the medical abortion procedure
Mifepristone given orally (Priming agent)
Misoprostol (4 tabs vaginally/ sublingually 48hrs after)
Which of the tablets involved in the medical abortion MUST be given on NHS premises?
Mifepristone must be given at NHS clinic
Misoprostol is now licensed for self-administration in the patients home (to prevent bleeding/ complications on transport home from clinic)
What can help mifepristone and misoprostol to be more effective after 10 wks gestation?
Further misoprostol doses due to later gestation
Medical abortion is only available for up to 20 weeks gestation in Scotland, however abortion is licensed up until week 24 in the UK. How can patients still have a medical abortion at >20 weeks?
Referred to services in England where the clinics will carry out medical abortions later than in Scotland
What groups of patients are recommended to stay at hospital during and after their misoprostol dose?
- patients who live far away from the hospital (incase of complications)
- those at higher risks of complications in the first place
- patients under 16 years of age
