Unplanned Pregnancy and Abortion Flashcards
What is clause A for grounds for termination?
Continuance of pregnancy would involve risk to the life of the pregnant women greater than if the pregnancy were terminated
What is clause B for grounds for termination?
Termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
What is clause C for grounds for termination?
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
What is clause D for grounds for termination?
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
What is clause E for grounds for termination?
Substantial risk that if the child were born it would suffer from physical or mental abnormalities as to be seriously handicapped
What are clauses F and G of the grounds for termination that can be performed in an emergency?
F; save life of pregnant woman
G; prevent grave permanent injury to physical or mental health of pregnant woman
What regimen is recommended for early medical abortion?
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
What is the regimen for medical abortion at 9-13 weeks gestation?
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
Can you take misoprostol at home?
Yes; if below 10 wks gestation, can be given at home but there must be an adequate support strategy and robust follow up arrangements
What is the name of the certificate for normal and emergency abortion?
Certificate A - 2 doctors must sign
Certificate B - emergency, only one doctor has to sign
What are the limits to conscientious objection?
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
What are the government standards regarding access to services surrounding abortion?
<5 days between referral and consultation
< 2weeks between referral and procedure
What determines the choice between a medical or surgical abortion?
Gestation
Patient preference
Regional availability
How is gestation assessed?
TVUSS
Can be estimated by LMP +/- date of +ve UPT
Palpable uterus = >12 weeks
What is the mode of action of mifepristone?
Antiprogesterone
Enhances uterine contractility
Increases prostaglandin receptors
What is the mode of action of misoprostol?
Prostaglandin
Can you access full abortion services in Scotland?
MToP avaliable up to 19 + 6 weeks in Scotland
If after this; need to travel to England
How is cervical priming achieved?
Via misoprostol or osmotic dilators; this causes softening of cervix and opening of the cervix
Reduces rate of uterine perforation or cervix trauma
What surgical abortion procedures can be performed <14 weeks?
Electric vacuum aspiration (GA)
Manual vacuum aspiration (10 wks; LA)
What surgical abortion procedures can be performed >14 weeks?
Dilation and evacuation
What are the possible complications of surgical abortions?
Haemorrhage +/- blood transfusion Failed/ incomplete abortion Infection Uterine perforation Cervical trauma
Who should receive antibiotic prophylaxis post abortion?
Those undergoing SToP
Those undergoing mToP with an increased risk of STI
What antibiotics are recommended for prophylaxis post abortion?
Doxycycline
Azithromycin
Who requires anti-D injections post abortion?
Rhesus neg woman who have a surgical abortion or those at late gestational age medical abortion
What should be given to high risk women for a VTE post abortion?
LMWH 1/52 post abortion
What should be given to very high risk women for VTE post abortion?
LMWH before abortion and continue for 6 weeks post abortion
What is one of the only CI to medical abortion?
Severe asthma; prostaglandins can exacerbate
When will ovulation occur post abortion?
> 90% will ovulate within 4 weeks but as early as 8 days
When can contraceptives be started post abortion?
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)
When should you avoid intrauterine methods for contraception post abortion?
Post-abortion sepsis
In the absence of sepsis, when can intrauterine methods be inserted post abortion?
Immediately after SToP or after MToP once expulsion confirmed
When can hormonal methods of contraception be started post abortion?
Any time after MToP or SToP including the day of mife/miso
When can non-hormonal methods of contraception be used post abortion?
Barrier anytime expect diaphragm after 2nd trim ToP
Sterilisation after some time has elapsed
Avoid FAM until regular periods resume
Is a USS required after an abortion?
No; there is no routine clinical or USS review
When should a pregnancy test be taken after EMAH?
Low sensitivity UPT at least 2 weeks post abortion
NOT a normal one as it may show positive when in fact not pregnant
What should you do if you have a positive pregnancy test 2 weeks post EMAH?
Return to clinic to have USS performed
If retained tissue; manage with antibiotics or surgical removal
