Unplanned Pregnancy Flashcards
How common are unplanned pregnancies?
30-50% of all pregnancies are unintended at conception = may be unplanned or mistimed
What are some of the poorer outcomes associated for mother and baby associated with unplanned pregnancy?
Later initiation and less frequent antenatal care
Increased preterm birth and low birthweight
Increased postnatal depression and substance abuse
Reduced breastfeeding and bonding with infant
Increased rates of child neglect and abuse
How common are abortions?
30-40% of unintended pregnancies end in abortion
Unsafe abortions account for 8 deaths per hour
What are some of the laws surrounding abortion?
Abortions Act 1967 = permits abortions in Scotland, England and Wales
What is the legislation around in abortions in Northern Ireland?
Used to only be permitted to prevent death or serious long term harm to mother = legislation changed in March 2020
How are abortions documented?
Certified under specific indication = 5 clauses A-E
Certified on HSA1 form = signed by 2 doctors
Two emergency clauses (F & G0) = one doctor signs (HSA2)
Who must all abortions be reported to?
The Chief Medical Officer = via abortion notification form (HSA4)
What are the most common certification of abortion in the UK?
98% are clause C = has gestational limit of 24 weeks
1-2% are clause E = has no gestational limit
What conditions does clause C allow abortions under?
If continuing the pregnancy would involve risk of injury to the physical or mental health of the mother or her family
What conditions does clause E allow abortions under?
If there is substantial risk that the child would be severely handicapped
What is the legislation applies to conscientious objection?
Clause within Abortion Act 1967 that allows health care professionals the right to refuse to participate in an abortion
What situations does conscientious objection to abortion not apply?
Doesn’t apply in emergency/life threatening situations
Shouldn’t delay or prevent patient’s access to care
Doesn’t apply to indirect tasks associated with abortion (e.g admin)
Who can refer a patient for an abortion?
Either via GP or SRH
Self-referral becoming more available
Where do abortion consultations take place?
In the SRH or in gynaecology setting
What are the target windows for seeing a patient that wants an abortion?
Aim <5 days between referral and consultation
Aim <2 weeks between referral and procedure
How can you assess the gestation of a pregnancy?
Clinical = estimated by LMP +/- date of positive UPT, palpable uterus >12 weeks US = frequently used to confirm gestation, abdominal or transvaginal (<6 weeks)
What does medical abortion (MTOP) involve?
Two medications = mifepristone 200mg PO, misoprostol 800mcg PV/SL (24-48 hrs later)
How is a medical abortion carried out <10 weeks gestation?
Called early medical abortion at home (EMAH) = can self administer misoprostol at home
How is a medical abortion carried out >10 weeks gestation?
Inpatient procedure = repeated dose of PV misoprostol
800mcg PV then 400mcg every three hours PV/PO/SL (up to four doses)
What gestation are MTOP offered up until in Scotland?
Available up to 19+6 weeks in most areas = once >20 weeks requires travel to England (BPAS)
Which age group are early medical abortions at home not recommended in?
Those aged <16 years old
What is given before surgical abortion?
Cervical priming via misoprostol or osmotic dilators
What surgical abortion methods are available before 14 weeks gestation?
Electric vacuum aspiration = general anaesthesia
Manual vacuum aspiration = up to 10 weeks, local anaesthetic
What surgical methods are available after 14 weeks gestation?
Dilation and evacuation
What gestation are surgical abortions (STOP) available up until in Scotland?
Available up until 14 weeks gestation = after 14 weeks requires travel to specialist centre in England
What are some complications of abortion?
Haemorrhage +/- blood transfusion = higher in STOP
Failed or incomplete abortion = higher in MTOP
Infection
Uterine perforation or cervical trauma = only for STOP
What patients are given antibiotic prophylaxis?
Those undergoing STOP
Those undergoing MTOP with increased risk of STI
What antibiotic prophylaxis is given?
7 days of doxycycline 100mg BD OR 1g oral azithromycin and 500mg daily for 2 days
What affect can an abortion have on women who are rhesus D negative blood group?
May be sensitising event = leads to formation of anti-D antibodies that can cross the placenta and destroy foetal red blood cells
What is given as prophylaxis to rhesus D negative women?
Anti-D Ig
What VTE prophylaxis is given?
High risk = LMWH for 1 week after abortion
Very high risk = consider starting LMWH before abortion and continuing for longer
What is covered in a pre-abortion consultation?
Feelings about pregnancy and full history
Assessment of gestation and discuss available options
Explore safeguarding risks and risks of procedures
Consent and STI testing
Contraception and follow up
What are some features of fertility following an abortion?
1 in 3 women in UK experience repeat abortion
Ovulation occurs in >90% within first month
At least 50% resume sexual activity 2 weeks post-abortion
When can contraception be started following an abortion?
Almost all kinds can be started at/soon after abortion = immediately effective if started within 5 days
What contraception should be made immediately available after an abortion?
Long acting reversible contraception = decreases rate of further unplanned pregnancy, removes need for further appointments
When can intra-uterine contraceptives be started after an abortion?
Can be inserted immediately after STOP or once expulsion of pregnancy has been confirmed in MTOP
Avoid in presence of post-abortion sepsis
When can hormonal contraceptives be started following an abortion?
Can be started any time after STOP/MTOP including the day of abortive pills
How long should you avoid using FAM contraception for after an abortion?
Until regular periods resume
How are STOPs and in patient MTOPs followed up?
No follow up for either, provided expulsion of pregnancy is confirmed after MTOP
How are early medical abortions at home followed up?
Low sensitivity UPT performed at least two weeks post abortion
How are most initial abortion consultations carried out since covid-19 pandemic?
Exclusively done over the phone
What changes have been made to abortions due to the covid-19 pandemic?
Mifepristone licensed for home use
Extension for home abortion gestation limit from 9+6 to 11+6 weeks
No need for US to proceed with abortion in some cases
No routine swabs or blood testing
What women would receive a US for their abortion since the pandemic?
Symptoms or risk factors for ectopic pregnancy
Uncertainty about dates
Before STOP in some areas
What are the contents of an early medical abortion at home patient pack?
Mifepristone 200mg, misoprostol 800mg, anti-emetic, analgesia, antibiotic, 6 weeks of progesterone-only pill, low sensitivity pregnancy test
