Unplanned Pregnancy Flashcards
What percentage of pregnancies are unintended at conception?
30-50%
How many women die due to unsafe abortions?
8 per hour
What is the most recent law regarding abortion in Scotland?
Human Fertilisation and Embryology Act 1990
Is abortion legal?
It remains illegal but there are exceptions to this act
Name the abortion documentation
Cerficate A/HSA1
Describe the documentation of abortion
2 doctors sign under one of 7 specific causes (5 are signed by two doctors, 2 are signed by one doctor in an emergency)
Who must any abortion be reported to?
HSA4 to regional CMO
What clause are most abortions signed under?
Clause C - continuing the pregnancy would involve risk of injury to the physical/mental health of the women or her existing children/family
What is the gestational limit on clause C?
24 weeks
What clause is the second most used?
Clause E - substantial risk that if the child were born it would suffer physical/mental abnormalities as to be seriously handicapped
What is the gestational limit of clause E?
No limit
What is conscientious objection?
Right to refuse to be involved in care
State the three limits of conscientious objection
- does not apply in emergency/life threatening situation
- should not delay/prevent access to care
- does not apply to ‘indirect’ tasks associated with abortion e.g administrative/supervision of staff
How can a woman access abortion services?
- GP
- Self -referral
- Sexual Health Clinic
How soon after referral will a woman be seen?
<5 days
After their initial consultation how soon will a procedure occur?
<2 weeks
What changes have been made in abortion services as a result of COVID?
- Mifepristone licensed for home administration
- Home abortion up to 11+6 weeks
- Select cases can proceed without ultrasound
- No routine swab/blood test
How is gestation calculated?
Estimated LMP +/- date of positive pregnancy test
Palpable uterus suggests >12 weeks
Abdominal or transvaginal US (<6 weeks)
Name three circumstances where a woman would be given an ultrasound during COVID
- symptoms/risk of ectopic pregnancy
- uncertainty of dates
- before STOP in some areas
What is the medical management of abortion <12 weeks?
Mifepristone and misoprostol at home, requires second half dose of misoprostol if >10 weeks or no bleeding within four hours
What is the medical management of abortion >12 weeks?
Inpatient, mifepristone followed by repeated IV doses of misoprostol (800mg then 400mg 3 hourly up to four times)
What type of drug is mifepristone?
Oral, anti-progesterone
What type of drug is misoprostol?
Prostaglandin that opens and softens the cervix
How do mifepristone and misoprostol work together?
Together cause the uterus to contract, the cervix to open and passage of pregnancy tissue - usually after an hour of misoprostol bleeding which increases over a few hours to cramps until tissue passes
In Scotland when is a medical abortion available until?
19+6 weeks
>20 weeks requires travel to England
What is a contraindication for an at home abortion?
Not recommended for those under 16 years old
What does a EMAH pack contain?
Mifepristone Misoprotol Anti-emetic Analgesia Antibiotics (doxycycline 7 day course) Contraception - 6/12 POP Contact leaflet and low sensitivity pregnancy test (2 weeks)
Before surgical abortion what must be done?
Cervical priming via misoprostol or osmotic dilators
What are osmotic dilators?
Place in cervical canal for a few hours, absorb fluid and the pressure encourages the cervix to open up
Describe surgical abortion <14 weeks
Electric vacuum aspiration - GA
Manual Vacuum aspiration - up to 10 weeks- LA
Describe surgical abortion >14 weeks
Dilatation and evacuation requires travel to england
State the complications associated with abortion
Haemorrhage/need for transfusion Failed/incomplete Infection Uterine perforation Cervical trauma
Describe rhesus iso-immunisation
Rhesus negative women an abortion may be a sensitising event - foetal cells containing D antigen access maternal circulation and create anti-bodies that can destroy a future rhesus positive baby. Anti-D Ig given to rhesus negative women.
Describe VTE prophylaxis
Physiological changes in the coagulation system occur in pregnancy and increase background risk. Risk assessment - high risk given LMWH for 1 month after abortion and if very high it is continued fo 6 months
How many women experience a repeat abortion?
1 in 3
How soon after abortion does a woman’s fertility return?
Ovulation occurs within the first month in >90% of women and at least 50% will resume sexual activity in 2 weeks
How soon after abortion should contraception be started?
Immediately/within 5 days to ensure it is effective straight away - if not use condoms for bridging period
What is the recommended form of contraception after abortion?
Long Acting Reversible Contraceptives
When should IUD be avoided?
Presence of infection
When should the diaphragm be avoided?
If 2nd trimester TOP as will need to wait for normal anatomy to return and be refitted
