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Repro and Sexual Health > Unplanned Pregnancy and Abortion > Flashcards

Unplanned Pregnancy and Abortion Flashcards

1
Q

What is clause A for grounds for termination?

A

Continuance of pregnancy would involve risk to the life of the pregnant women greater than if the pregnancy were terminated

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2
Q

What is clause B for grounds for termination?

A

Termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman

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3
Q

What is clause C for grounds for termination?

A

Pregnancy has not exceeded 24th week and the continuance of pregnancy would involve risk, greater than if the pregnancy was terminated, of injury to the physical or mental health of the pregnant woman

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4
Q

What is clause D for grounds for termination?

A

Pregnancy has not exceeded 24th week and the continuance of pregnancy would involve risk, greater than if the pregnancy was terminated, of injury to the physical or mental health of any existing children of the family of the pregnant woman

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5
Q

What is clause E for grounds for termination?

A

Substantial risk that if the child were born it would suffer from physical or mental abnormalities as to be seriously handicapped

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6
Q

What are clauses F and G of the grounds for termination that can be performed in an emergency?

A

F; save life of pregnant woman

G; prevent grave permanent injury to physical or mental health of pregnant woman

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7
Q

What regimen is recommended for early medical abortion?

A

Mifepristone 200 mg PO followed 24-48 hours later by misoprostol 800 mcg given vaginally, buccal or sublingual route
If abortion has not occured 4 hours after administration of misoprostol, a second dose can be given

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8
Q

What is the regimen for medical abortion at 9-13 weeks gestation?

A

Mifepristone 200 mg PO followed 36-48 hours later by misoprostol 800 mcg vaginally
A ma of 4 further doses at 3 hourly intervals can be given

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9
Q

Can you take misoprostol at home?

A

Yes; if below 10 wks gestation, can be given at home but there must be an adequate support strategy and robust follow up arrangements

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10
Q

What is the name of the certificate for normal and emergency abortion?

A

Certificate A - 2 doctors must sign

Certificate B - emergency, only one doctor has to sign

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11
Q

What are the limits to conscientious objection?

A

Emergency in life threatening situations
Should not delay or prevent a patient’s access to care
Does not apply to indirect tasks associated with abortion e.g. administrative, supervision of staff

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12
Q

What are the government standards regarding access to services surrounding abortion?

A

<5 days between referral and consultation

< 2weeks between referral and procedure

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13
Q

What determines the choice between a medical or surgical abortion?

A

Gestation
Patient preference
Regional availability

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14
Q

How is gestation assessed?

A

TVUSS
Can be estimated by LMP +/- date of +ve UPT
Palpable uterus = >12 weeks

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15
Q

What is the mode of action of mifepristone?

A

Antiprogesterone
Enhances uterine contractility
Increases prostaglandin receptors

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16
Q

What is the mode of action of misoprostol?

A

Prostaglandin

17
Q

Can you access full abortion services in Scotland?

A

MToP avaliable up to 19 + 6 weeks in Scotland

If after this; need to travel to England

18
Q

How is cervical priming achieved?

A

Via misoprostol or osmotic dilators; this causes softening of cervix and opening of the cervix
Reduces rate of uterine perforation or cervix trauma

19
Q

What surgical abortion procedures can be performed <14 weeks?

A

Electric vacuum aspiration (GA)

Manual vacuum aspiration (10 wks; LA)

20
Q

What surgical abortion procedures can be performed >14 weeks?

A

Dilation and evacuation

21
Q

What are the possible complications of surgical abortions?

A 
Haemorrhage +/- blood transfusion 
Failed/ incomplete abortion 
Infection 
Uterine perforation 
Cervical trauma
22
Q

Who should receive antibiotic prophylaxis post abortion?

A

Those undergoing SToP

Those undergoing mToP with an increased risk of STI

23
Q

What antibiotics are recommended for prophylaxis post abortion?

A

Doxycycline

Azithromycin

24
Q

Who requires anti-D injections post abortion?

A

Rhesus neg woman who have a surgical abortion or those at late gestational age medical abortion

25
Q

What should be given to high risk women for a VTE post abortion?

A

LMWH 1/52 post abortion

26
Q

What should be given to very high risk women for VTE post abortion?

A

LMWH before abortion and continue for 6 weeks post abortion

27
Q

What is one of the only CI to medical abortion?

A

Severe asthma; prostaglandins can exacerbate

28
Q

When will ovulation occur post abortion?

A

> 90% will ovulate within 4 weeks but as early as 8 days

29
Q

When can contraceptives be started post abortion?

A

If started on the day or within 5 days; immediately effective
If started after 5 days; efficacy depends on method (2 days for POP, 7 days for CHC/DMPA/SDI/LGN-IUS)

30
Q

When should you avoid intrauterine methods for contraception post abortion?

A

Post-abortion sepsis

31
Q

In the absence of sepsis, when can intrauterine methods be inserted post abortion?

A

Immediately after SToP or after MToP once expulsion confirmed

32
Q

When can hormonal methods of contraception be started post abortion?

A

Any time after MToP or SToP including the day of mife/miso

33
Q

When can non-hormonal methods of contraception be used post abortion?

A

Barrier anytime expect diaphragm after 2nd trim ToP
Sterilisation after some time has elapsed
Avoid FAM until regular periods resume

34
Q

Is a USS required after an abortion?

A

No; there is no routine clinical or USS review

35
Q

When should a pregnancy test be taken after EMAH?

A

Low sensitivity UPT at least 2 weeks post abortion

NOT a normal one as it may show positive when in fact not pregnant

36
Q

What should you do if you have a positive pregnancy test 2 weeks post EMAH?

A

Return to clinic to have USS performed

If retained tissue; manage with antibiotics or surgical removal

Repro and Sexual Health (77 decks)

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