unplanned pregnancy and psychosexual probs Flashcards
is TOP safe
yes, safer than continuing pregnancy to term
legal requirements for TOP
two registered medical practitioners are of the opinion that an abortion is justified
a registered medical practitioner must carry out the abortion
must take place in an NHS hospital or approved premises
grounds for termination
A -pregnancy involves grater risk to life of pregnant woman than TOP
B - necessary to prevent grave permanent injury to physical/mental health of woman
C - pregnancy has not exceeded its 24th week and continuance would involve risk of injury to physical or mental health of woman
D - pregnancy has not exceeded its 24th week and would involve hisk to existing children
E - substantial risk that if the child was born it would suffer from severe physical or mental abnormalities
grounds for emergency TOP
F - it was necessary to save the life of the woman
G - it was necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
conscientious objection
respect patient’s dignity; avoid discrimination
must not impose views on others but may explain if invited
ensure patient’s treatment is not denied or delayed
timely onward referral to a colleague
treatment in an emergency can’t be objected to
what happens in initial TOP consultation
certainty to proceed/discuss alternatives
USS - confirm IUP, determine gestation
complete medical history
discuss suitable methods of TOP
legal limit for TOP
for social TOP - 23 weeks 6 days
for foetal anomaly - any gestation
(NHS Tayside is 18 weeks 6 days)
medical TOP procedure
stage 1: oral mifepristone 200 mg (anti-progesterone)
stage 2: 24-48 hours later PV/PO prostaglandin (misoprostol/gemeprost)
if <9 weeks stage 2 can be completed at home
if later may required repeated doses of prostaglandin 3 hourly (up to 5)
surgical TOP methods
vacuum aspiration 6-12 weeks
dictation and evacuation 13-24 weeks (not available in Scotland)
surgical TOP procedure
cervical priming with PV prostaglandins
day case
LARC fitting at procedure
manual vacuum aspiration
up to 9 weeks
local anaesthetic
complications of TOP
pain haemorrhage infection incomplete/failed procedure uterine perforation cervical trauma anaesthetic complications ongoing pregnancy uterine rupture
TOP aftercare
pregnancy test 2-3 weeks
risk of ongoing pregnancy/retained tissues
anti-D within 72 hours
contraception
what is psychosexual dysfunction
a disturbance of sexual functioning
may be caused by physiological and emotional difficulties concerning sexuality rather than physical disorders
common triggers of sexual problems
after child brith after gynae/other cancers after gynae surgery menopause Hx of abuse following pelvic infection intercurrent illness or disability
