Unplanned pregnancy and abortion Flashcards
What percentage of pregnancies are unplanned?
20-50%
What percentage of unplanned pregnancies lead to abortion?
30-40%
For a planned abortion - what must be signed and by who?
certificate A
by two doctors
For an emergency abortion - what must be signed and by who?
certificate A
by one doctor
What consitutes an emergency abortion?
abortion is needed to save a mothers life
What is the most common HSA1 form catagory for abortion?
C - pregnancy has not exceeded 24th week and continuing the pregnancy would cause physical or mental harm to the mother
What HSA1 form catagory has no gestational limit?
E - carrying on the pregnancy would mean that the child would be severely handicapped
What should be the time period between referral and consultation?
<5 days
What should be the time period between referral and procedure?
<2 weeks
What is the medical option for termination?
Mifepristone 200mg PO then 24-48hrs later Misoprostol 200mcg PV
Where can misoprostol be given if the termination is under 10 weeks?
at home
Can those under 16yrs take misoprostol at home?
NO
How is misoprostol given if over 10 weeks?
in patient
800mcg to begin with
then 400 mcg 3 hourly
Up to how many weeks is medical abortion allowed?
19+6
If you are over 19+6 weeks and want a medical abortion, what happens?
you go to England
What is the legal limit for termination of pregnancy?
23+6
What are the surgical abortion methods for under 14 weeks?
electric vacuum aspiration or manual vaccum aspiration
What are the surgical abortion methods for over 14 weeks?
dilation and evacuation - only in england
What must you obtain before an abortion?
written consent
What are the possible complications of abortion?
haemorrhage infection uterine perforation - only surgical cervical trauma - only surgical failed/incomplete abortion
What prophylaxis should be given to those undergoing a surgical abortion?
infection = antibiotics VTE = LMWH (if high risk)
Does fertility change after an abortion?
no
What contraception can be provided immediately after an abortion?
pretty much them all apart from - diaphragm
What follow up is used for abortions?
2 weeks after do a urine pregnancy test - to identify failed or complete procedure
What is rape?
penetration of the vagina, anus or mouth by the penis without consent
How long can sperm last in the female genital tract?
5 days
How long can an ovum last in the female genital tract?
24 hours
What are the 3 types of emergency contraception?
progesterone only - Levenogestrel
selective progesterone receptor modulator - Ulipristal
Copper IUD
How does mifepristone work?
enhances uterine activity and increases prostaglandin receptors
When can levenogestrel be taken after sex for protection?
up to 72hours - more effective the earlier
How does levonogestrel work?
high dose progesterone - so delays ovulation
What is the effectiveness of levonorgestrel?
50-100%
must use barrier form of contraception for 7 days after
How often can levonogestrel be used in a cycle?
more than once
What is the mode of action of Ullipristal?
selective progesterone receptor modulator
delays ovulation and has endometrial effects
When can Ullipristal be taken after unprotected sex?
up to 5 days - 90% effective
Why must you wait 5 days before starting hormonal contraception after using Ullipristal?
may decrease the effectiveness
When is Ullipristal contraindicated?
those on steroids for uncontrolled/acute asthma
What is the most effective method of emergency contraception?
Copper IUD
How does the copper IUD work?
toxic to the sperm so prevents fertilisation and implantation
When can the copper IUD be taken after unprotected sex?
up to 5 days after
nearly 100% effective
Why can both the copper IUD and Ullipristal be given up to 5 days after unprotected sex?
pregnancy doesnt implant until day 8-10
