Unplanned Pregnancy Flashcards

1
Q

What percentage of pregnancies are unintended at conception?

A

30-50%

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2
Q

How many women die due to unsafe abortions?

A

8 per hour

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3
Q

What is the most recent law regarding abortion in Scotland?

A

Human Fertilisation and Embryology Act 1990

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4
Q

Is abortion legal?

A

It remains illegal but there are exceptions to this act

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5
Q

Name the abortion documentation

A

Cerficate A/HSA1

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6
Q

Describe the documentation of abortion

A

2 doctors sign under one of 7 specific causes (5 are signed by two doctors, 2 are signed by one doctor in an emergency)

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7
Q

Who must any abortion be reported to?

A

HSA4 to regional CMO

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8
Q

What clause are most abortions signed under?

A

Clause C - continuing the pregnancy would involve risk of injury to the physical/mental health of the women or her existing children/family

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9
Q

What is the gestational limit on clause C?

A

24 weeks

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10
Q

What clause is the second most used?

A

Clause E - substantial risk that if the child were born it would suffer physical/mental abnormalities as to be seriously handicapped

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11
Q

What is the gestational limit of clause E?

A

No limit

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12
Q

What is conscientious objection?

A

Right to refuse to be involved in care

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13
Q

State the three limits of conscientious objection

A
  • 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
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14
Q

How can a woman access abortion services?

A
  • GP
  • Self -referral
  • Sexual Health Clinic
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15
Q

How soon after referral will a woman be seen?

A

<5 days

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16
Q

After their initial consultation how soon will a procedure occur?

A

<2 weeks

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17
Q

What changes have been made in abortion services as a result of COVID?

A
  • Mifepristone licensed for home administration
  • Home abortion up to 11+6 weeks
  • Select cases can proceed without ultrasound
  • No routine swab/blood test
18
Q

How is gestation calculated?

A

Estimated LMP +/- date of positive pregnancy test
Palpable uterus suggests >12 weeks
Abdominal or transvaginal US (<6 weeks)

19
Q

Name three circumstances where a woman would be given an ultrasound during COVID

A
  • symptoms/risk of ectopic pregnancy
  • uncertainty of dates
  • before STOP in some areas
20
Q

What is the medical management of abortion <12 weeks?

A

Mifepristone and misoprostol at home, requires second half dose of misoprostol if >10 weeks or no bleeding within four hours

21
Q

What is the medical management of abortion >12 weeks?

A

Inpatient, mifepristone followed by repeated IV doses of misoprostol (800mg then 400mg 3 hourly up to four times)

22
Q

What type of drug is mifepristone?

A

Oral, anti-progesterone

23
Q

What type of drug is misoprostol?

A

Prostaglandin that opens and softens the cervix

24
Q

How do mifepristone and misoprostol work together?

A

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

25
Q

In Scotland when is a medical abortion available until?

A

19+6 weeks

>20 weeks requires travel to England

26
Q

What is a contraindication for an at home abortion?

A

Not recommended for those under 16 years old

27
Q

What does a EMAH pack contain?

A
Mifepristone 
Misoprotol 
Anti-emetic
Analgesia
Antibiotics (doxycycline 7 day course)
Contraception - 6/12 POP 
Contact leaflet and low sensitivity pregnancy test (2 weeks)
28
Q

Before surgical abortion what must be done?

A

Cervical priming via misoprostol or osmotic dilators

29
Q

What are osmotic dilators?

A

Place in cervical canal for a few hours, absorb fluid and the pressure encourages the cervix to open up

30
Q

Describe surgical abortion <14 weeks

A

Electric vacuum aspiration - GA

Manual Vacuum aspiration - up to 10 weeks- LA

31
Q

Describe surgical abortion >14 weeks

A

Dilatation and evacuation requires travel to england

32
Q

State the complications associated with abortion

A
Haemorrhage/need for transfusion 
Failed/incomplete 
Infection 
Uterine perforation 
Cervical trauma
33
Q

Describe rhesus iso-immunisation

A

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.

34
Q

Describe VTE prophylaxis

A

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

35
Q

How many women experience a repeat abortion?

A

1 in 3

36
Q

How soon after abortion does a woman’s fertility return?

A

Ovulation occurs within the first month in >90% of women and at least 50% will resume sexual activity in 2 weeks

37
Q

How soon after abortion should contraception be started?

A

Immediately/within 5 days to ensure it is effective straight away - if not use condoms for bridging period

38
Q

What is the recommended form of contraception after abortion?

A

Long Acting Reversible Contraceptives

39
Q

When should IUD be avoided?

A

Presence of infection

40
Q

When should the diaphragm be avoided?

A

If 2nd trimester TOP as will need to wait for normal anatomy to return and be refitted