Unplanned Pregnancy Flashcards
what percentage of pregnancies are unintended globally?
30-50%
What are the poorer outcomes if an unintended pregnancy is continued?
- 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
What % of unintended pregnancies end in abortion?
30-40%
How many deaths an hour does unsafe abortion cause?
8
When will abortion law changes in NI come into place?
march 2020
What indication is abortion certified under?
5 clauses A to E
What form is abortion certified on?
HSA1- two doctors sign
How is emergency abortion certified?
Emergency causes- F & G - one doctor signs
Who must be informed about all abortions?
CMO under abortion notification form
What is clause C?
- 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)
What is the second commonest abortion clause?
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
When does conscientious objection not apply?
- 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
Who provides the national clinical guidance?
NICE and RCGO
How long should be aimed for between referral and consultations?
<5 days
How long should be aimed for between referral and procedure?
<2 weeks
What age range has the highest rate of abortions?
20-24 years
What are the methods of abortion?
Medical or surgical
What may influence the choice of abortion method?
Gestation
Patient preference
Regional availability
How is the clinical assessment of gestation made?
Estimated by LMP +/- date of +ve UPT
Palpable uterus >12 weeks
How is the ultrasound assessment of gestation made?
Abdominal or transvaginal (<6 weeks)
What medications are involved in medical abortion?
Mifepristone 200mg PO
Misoprostol 800mcg PV/SL (24-48 hours later)
What is the protocol for medical abortion if <10 weeks gestation?
Can self-administer misoprostol at home
What is the protocol for medical abortion if >10 weeks gestation?
Inpatient procedure;
Repeated doses of PV miosoprostol 800mcg PV then 400mcg 3-hourly PV/PO/SL (up to 4)
Describe a surgical abortion
Removal of PoC via surgical procedure under anaesthesia, cervical priming via misoprostol or osmotic dilators
What is the protocol for surgical abortion if <14 weeks
- electric vacuum aspiration (GA)
- manual vacuum aspiration (up to 10 weeks; local anaesthetic)
What is the protocol for surgical abortion if >15 weeks
Dilatation and evacuation
When is STOP available until in Scotland
14 weeks
What are the possible complications of abortion?
- Haemorrhage +/- blood transfusion
- Failed/incomplete abortion
- Infection
- uterine perforation (surgical risk only)
- cervical trauma (surgical risk only)
Who should be given antibiotic prophylaxis at time of abortion?
- those undergoing STOP
- those undergoing MTOP with an increased risk of STI (if screening not performed/results not available)
What are the recommended regimens for antibiotic prophylaxis?
- 7 days 100mg doxycycline BD OR 1g oral azithromycin + 500mg daily for 2 days
- Routine metronidazole should no longer be offered with above
Who should be given anti-D Ig?
Women with a rhesus D -ve blood group
What should be given to high VTE risk women?
LMWH for 1/52 after abortion
What should be given to very high VTE risk women?
LMWH before abortion and continue for longer
When does ovulation occur after abortion?
Occurs in >90% within 1st month (As early as 8 days after early medical)
When do 50% of women resume sexual activity after abortion?
Within 2 weeks
When does POP become effective if started 5 days after abortion?
2 days
When does CHC/DMPA/SDI/IUS become effective if started 5 days after abortion?
7 days
When should intra-uterine methods (IUS, IUD) be started after abortion?
Can be inserted immediately after STOP or after MTOP once expulsion of pregnancy confirmed
When should intra-uterine methods (IUS, IUD) be avoided after abortion?
Post-abortion sepsis
When should hormonal methods (CHC, SDI, SMPA, POP) be started after abortion?
Anytime after MTOP/STOP including day of mife/miso
When can barrier methods be used after abortion?
Barrier methods can be used anytime- except diaphragm after 2nd trimester TOP
Sterilisation after some time has elapsed
What is the follow up after early medical abortion at home?
Low-sensitivity UPT performed at least 2 weeks after abortion, to identify incomplete or failed procedure
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