Unplanned Pregnancy Flashcards
What are the options available for pregnancy?
- continue with the PREGNANCY and keep baby
- ABORTION
- continue and have the baby ADOPTION
Termination of pregnancy commonly seen in which age group?
20-24 yr group
What is the mortatility rate from abortion?
0.6/100000
When can an abortion take place according to the Abortion Act 1967?
- only if 2 registered medical practitioners are present
According to the Abortion Act 1967, who can terminate pregnancy?
- registered medical practitioner
What is the abortion form of HSA 1 (Certificate A) require?
- 2 doctors are REQUIRED to sign the HSA1 form
When should the HCA2 (Cert. B) form be completed by?
- completed by the doctor within 24hrs of an emergency abortion
When should the HSA4 form be completed by and who should it be send to ?
- completed by the doctor and send to the CMO within 7 days of the abortion
Which situation does certificate A apply?
- continuance of pregnancy would involve RISK to life of pregnant woman GREATER than if the pregnancy were terminated
When does the certificate B apply ?
- when termination is necessary to PREVENT permanent injury to Physical and mental health of women
Certificate C applies to ______?
- when pregnancy has NOT exceeded ts 24th week and continuance of pregnancy is risky! (greater than if preg. was terminated/ or when there injury to physical/mental health)
Certificate E?
- when there is a SUBSTANTIAL risk that if a child were born, it would suffer from physical and mental abnormalities
What are ethical aspects should be considered with abortion?
- UNder 16?
- Learning disability of the kid
- HIV positive
- Patient confidentiality
- Domestic abuse
Are doctors allowed to “opt out” of certain procedures because of personal values/beliefs?
- YES
- according to the Abortion Act they can opt out if they have a “conscientious objection”
How may a doctor handle a situation where he doesn’t want to engage in because it conflicts with his/her religious and molar beliefs?
- as it may affect the RX and ADVICE he/she may give to the pt; the doctor would have to EXPLAIN (with suff. information) to the patient that they have the right to see another doctor
- —-make arrangements for another suitably qualified colleague
What points should be considered when a doctor makes a conscientious objection to treating a pt?
- respect the pt’s DIGNITY and views
- do NOT IMPOSE views on others (explain your view; if INVITED)
- ensure the pt’s rx is NOT DELAYED /denied
- timely onward referral to a colleague
When may a conscientous objection be rejected?
- when treatment is in the event of an EMERGENCY
What does the initial consultation entail at TOP clinic?
~1hr
- certainty to discuss alternatives
- USG (confirm IUP, determine gestation)
- complete MEDICAL hx
- discussion of methods for TOP
What is required prior to TOP?
- written CONSENT for procedures and fetal remains
- Bloods (FBC/-BBV/G&S+)
- screening for STI
- prophylactic antibiotics
- counselling for ongoing contraception
What is the LEGAL limit for SOCIAL termination of pregnancY?
23 weeks and 6 days
Legal limit for fetal anomaly termination?
- any gestation
Up till when may a pregnancy be terminated surgically? (NHS Tayside)
- up to 12 weeks
When may medical termination be allowed to occur up to?
- up to 18 weeks and 3 days
When is it considered to be LATE termination?
- 9-12 weeks
What the maximum gestational period at which TOP may occur?
- Mid-trimester
12-24 weeks
What is involved in medical TOP?
2 stage process:
1. Oral MIFEPRISTONE 200mg (anti-progesterone)
- 24-48 hrs later- VAGINAL (or oral) prostaglandin —-misoprostol
Is the medical TOP done at home?
- if EARLY TOP (<9weeks); option to COMPLETE 2nd part at home
- Late/Mid-Trimester: repeated doses of prostaglandin 3hrly (max5 in 24hrs)
Failure of medical TOP, will require surgical intervention. NAme the 2 methods and at which gestational period its ideal?
- 6-12 weeks: Vacuum Aspiration (day case, GA, electric vacuum aspiration techn.)
- 13-24 wks: Dilatation and Evacuation
What is prinicipally noted in Surgical TOP ?
- day case with GA
- routine USS not required
- LARC (long acting reversible contraceptive) fitting at procedure
What are the complications of TOP>
risk: 1-2/1000
- pain/hemorrhage/infection /cervical trauma (1 in 100) / uterine perforation (1 to 4/1000)/ anaesthetic complications/ uterine rupture
What is an alternative to the electric vacuum aspiration ?
- for EARLY gestation
> Manual Vacuum Aspiration
> up to 9 weeks
—–for resource poor setting
What entails the aftercare for TOP?
- follow-up (urine preg. test at 2-3wks)
- risk of retained tissues
- Anti-D within 72 hrs
- 24hr contact info/leaflets to SEEK help
- refer to sexual and reproductive health
- counsellin
- Contraception
What is psychosexual dysfunction?
- disturbance in SEXUAL functioning
- —d/t psychological and emotional difficulties concerning SEXUALITY
Name female examples of psychosexual dysfunction?
- vaginismus
- dyspareunia
Male psychosexual dysfunction?
ED
PE (premature ejacut.)
delayed ejaculation
How may psychosexual dysfxn present as directly?
- loss of desire
- non-consummation
- erectile diff.
- avoidance of relationships
Indirect presentation of psychosexual dysfxn?
- freq. STI checks
- chronic pelvic PAIN/discharge
- avoidance of cx smear
- chronic symptoms (no cause)
- —-fear of pregn.
Most common and the most PERSISTENT psychosexual problems WOMEN face ?
- Anorgasmia, dyspareunia
2. persistent: Loss of Libido
What does psychodynamic psychotherapy look into?
- underlying CAUSES of sexual dysfunction
- looks at SD as a symptom
- vaginal/genital exam used to exam psychological and physical state of mind
What acc occurs at psychodynamic therapy?
- therapist explore FEELINGS, thoughts and experiences of SD
- –how SD manifests in other ways (in pts life, relationships)
What is meant by free-floating attention?
When with the pt, notice:
- what are they like? (demeanor) Opening words?
- how are you feeling? Are you acting any diff.?
- Their choice of words
- how does the consultation end?
