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Reproductive & Sexual Health > Unplanned Pregnancy > Flashcards

Unplanned Pregnancy Flashcards

1
Q

what percentage of pregnancies are unintended globally?

A

30-50%

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2
Q

What are the poorer outcomes if an unintended pregnancy is continued?

A
  • Later initiation and less frequent antenatal care
  • increased preterm birth and low birthweight
  • increased postpartum depression and substance misuse
  • reduced breastfeeding rates
  • decreased bonding with infant
  • increased rates of child neglect and abuse
  • poorer long-term developmental outcome
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3
Q

What % of unintended pregnancies end in abortion?

A

30-40%

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4
Q

How many deaths an hour does unsafe abortion cause?

A

8

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5
Q

When will abortion law changes in NI come into place?

A

march 2020

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6
Q

What indication is abortion certified under?

A

5 clauses A to E

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7
Q

What form is abortion certified on?

A

HSA1- two doctors sign

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8
Q

How is emergency abortion certified?

A

Emergency causes- F & G - one doctor signs

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9
Q

Who must be informed about all abortions?

A

CMO under abortion notification form

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10
Q

What is clause C?

A
  • 98% of abortions are certified under clause C
  • gestational limit of 24 weeks
  • continuing the pregnancy would involve risk of injury to the physical or mental health of the pregnant women or her existing children/family (greater than if the pregnancy were terminated)
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11
Q

What is the second commonest abortion clause?

A

E (1-2%)

  • no gestational limit
  • substantial risk that if the child it were born it would suffer from such physical or mental abnormalities as to be seriously handicapped
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12
Q

When does conscientious objection not apply?

A
  • does not apply in emergency or life-threatening situations
  • should not delay or prevent a patients access to care
  • does not apply to indirect tasks associated with abortion e.g. administrative, supervision of staff
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13
Q

Who provides the national clinical guidance?

A

NICE and RCGO

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14
Q

How long should be aimed for between referral and consultations?

A

<5 days

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15
Q

How long should be aimed for between referral and procedure?

A

<2 weeks

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16
Q

What age range has the highest rate of abortions?

A

20-24 years

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17
Q

What are the methods of abortion?

A

Medical or surgical

18
Q

What may influence the choice of abortion method?

A

Gestation
Patient preference
Regional availability

19
Q

How is the clinical assessment of gestation made?

A

Estimated by LMP +/- date of +ve UPT

Palpable uterus >12 weeks

20
Q

How is the ultrasound assessment of gestation made?

A

Abdominal or transvaginal (<6 weeks)

21
Q

What medications are involved in medical abortion?

A

Mifepristone 200mg PO

Misoprostol 800mcg PV/SL (24-48 hours later)

22
Q

What is the protocol for medical abortion if <10 weeks gestation?

A

Can self-administer misoprostol at home

23
Q

What is the protocol for medical abortion if >10 weeks gestation?

A

Inpatient procedure;

Repeated doses of PV miosoprostol 800mcg PV then 400mcg 3-hourly PV/PO/SL (up to 4)

24
Q

Describe a surgical abortion

A

Removal of PoC via surgical procedure under anaesthesia, cervical priming via misoprostol or osmotic dilators

25
Q

What is the protocol for surgical abortion if <14 weeks

A
  • electric vacuum aspiration (GA)

- manual vacuum aspiration (up to 10 weeks; local anaesthetic)

26
Q

What is the protocol for surgical abortion if >15 weeks

A

Dilatation and evacuation

27
Q

When is STOP available until in Scotland

A

14 weeks

28
Q

What are the possible complications of abortion?

A
  • Haemorrhage +/- blood transfusion
  • Failed/incomplete abortion
  • Infection
  • uterine perforation (surgical risk only)
  • cervical trauma (surgical risk only)
29
Q

Who should be given antibiotic prophylaxis at time of abortion?

A
  • those undergoing STOP

- those undergoing MTOP with an increased risk of STI (if screening not performed/results not available)

30
Q

What are the recommended regimens for antibiotic prophylaxis?

A
  • 7 days 100mg doxycycline BD OR 1g oral azithromycin + 500mg daily for 2 days
  • Routine metronidazole should no longer be offered with above
31
Q

Who should be given anti-D Ig?

A

Women with a rhesus D -ve blood group

32
Q

What should be given to high VTE risk women?

A

LMWH for 1/52 after abortion

33
Q

What should be given to very high VTE risk women?

A

LMWH before abortion and continue for longer

34
Q

When does ovulation occur after abortion?

A

Occurs in >90% within 1st month (As early as 8 days after early medical)

35
Q

When do 50% of women resume sexual activity after abortion?

A

Within 2 weeks

36
Q

When does POP become effective if started 5 days after abortion?

A

2 days

37
Q

When does CHC/DMPA/SDI/IUS become effective if started 5 days after abortion?

A

7 days

38
Q

When should intra-uterine methods (IUS, IUD) be started after abortion?

A

Can be inserted immediately after STOP or after MTOP once expulsion of pregnancy confirmed

39
Q

When should intra-uterine methods (IUS, IUD) be avoided after abortion?

A

Post-abortion sepsis

40
Q

When should hormonal methods (CHC, SDI, SMPA, POP) be started after abortion?

A

Anytime after MTOP/STOP including day of mife/miso

41
Q

When can barrier methods be used after abortion?

A

Barrier methods can be used anytime- except diaphragm after 2nd trimester TOP

Sterilisation after some time has elapsed

42
Q

What is the follow up after early medical abortion at home?

A

Low-sensitivity UPT performed at least 2 weeks after abortion, to identify incomplete or failed procedure
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Reproductive & Sexual Health (54 decks)

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