Week 1 - Termination of Pregnancy Tutorial (day 1) Flashcards
Would you normally screen for herpes?
Amy has been offered screening for STIs as she had unprotected sex
Screen for Chlamydia, Gonorrhea, Hepatitis B (maybe C if there was a lot of blood involved), HIV, Syphilis
Would only screen for herpes if the patient was symptomatic
How is screening for chlamydia trachomatis and gonorrhea carried out? How would she be screened for syphilis?
Swab for NAAT test (PCR is the form of NAAT test used probably)
Vulvovaginal swab can be self carried out by the patient
If symptomatic could carry out a speculum and endocervical swab of the patient
Syphilis screen would be IgG and IgM Elisa antibodies in blood
what advice should she be given to reduce the risk of exposure to STIs in the future?
Use barrier protection eg condom
Maybe sleep with those who you know and trust
if her screening comes back positive, what management should be considered? Ie for chlamydia, gonorrhea, HIV, herpres, syphilis
- Chalmydia - Doxycycline (100mg/7days) or Azithromycin (1g/day 1 then 500mg/2 days)
- Gonorrhea - [IM ceftriaxone + oral azithromycin]
- HIV - HAART (Highly active anti-retroviral therapy) - a combination of three drugs from at least 2 drug classes that the virus is susceptible to
- Herpes - oral acyclovir
- Syphilis -
- early stage - 2.4 MU benzathine penicillin G,
- late stage = 2.4 benzathine penicillin G (x3)
What does the bezathine part of the penicillin treatment for syphilis do? What is the difference between penicillin V and G?
The benzathine component slowly releases the penicillin making the combination long-acting
Penicillin V - phenoxymethyl penicillin - can be taken orally
Penicilline G - benzylpenicillin - taken IM or IV
What methods are available for termination of pregnancy?
Can try the abortion pill or surgical abortion
How long can abortion pill or surgical abortion procedure be carried out until? What two pills are given in abortion pill method?
Both surgical and medication abortion can be carried out until 24 weeks (23 weeks 6 days)
The anti-progesterone mifepristone is given and the prostoglandin analogue misoprostolol
How is the abortion pill method carried? What is the change at 9 weeks?
Single oral dose of Mifepristone and one dose of misoprostolol at less than or equal to 63 days
At 64 days to 24 weeks, single oral dose of mifepristone and multiple doses of misoprostolol
What are the two types of surgical abortion and when are they carried out? What type of anaesthetic is usually used in both types of abortion?
Vacuum aspiration - can be carried out up until 15 weeks - usually done under local anaesthetic
Dilatation and evacuation is carried out 13-24 weeks - usually under general anaesthetic
What has to happen the day of surgery for a dilatation and evacuation surgical abortion?
Due to pregnancy being removed by usuing narrow forceps through the neck of the womb, cervical preparation is require - the drug misoprostolol is therefore given for cervical prep on surgical day
How are the drugs taken in the medication abortion? Which is more successful, abortion pill or surgical abortion? What are the advantages and disadvantages of both?
- Anti-progestogen mifepristone is taken orally
- Misoprostolol is taken vaginally
Surgical abortion is more successful - 99%, abortion pill is 97% success rate
Pros -
- Abortion pill - no anaesthia, seems more natural
- Surgical abortion - highly successful and less bleeding
Disadvantages
- Abortion pill - heavy bleeding, two visits, severe cramping
- Surgical abortion - aneasthesia and invasive
What is there a risk of perforation that should be discussed with the patient when carrying out a surgical abortion?
There is a risk of uterine perforation
What is the advised contraception for anyone who has had an unplanned pregnancy?
The advised contraception is a LARC Long acting reversible contraception
Long-acting reversible contraceptives (LARC) are methods of birth control that provide effective contraception for an extended period without requiring user action. They include injections, intrauterine devices (IUDs), intrauterine systems (IUS) and subdermal contraceptive implants. Intrauterine contraception (IUC) is highly effective and long-acting. What is the first choice intrauterine contraception? WHat is therefore second line?
Copper bearing intrauterine device is the first line (Cu-IUD)
Levenogestrel bearing intrauterine system (LNG-IUS)
How does the intrauterine device work? How long does it last for? What are the side effects?
It is a copper coil that creates a toxic environment for the sperm
Lasts for 5-10 years depending on the type of coil
Side effects of copper coil include heavy periods
How long does the LNG-IUS last for? What hormone does it contain?
Lasts 3-5 years and contains progesterone only
How long has to be waited after an abortion to insert intrauterine contraception?
IUC can be inserted immediately after an abortion
How does the copper coil prevent pregnancy? How does the IUS prevent pregnancy? (mirena coil)
Copper coil stops sperm surviving and thickens cervical mucus to prevent sperm from enterine the uterus
IUS - releases prgesterone which thickens cervical mucus and thins the endometriu, also prevents ovum from being released
5) Law and ethics If Amy decides on a termination of pregnancy - under what statutory ground could this be certified?
The abortion act 1967
Which professionals currently have to sign the abortion act 1967 forms?- under what circumstances can professionals decide not to treat someone if they conscientiously object to termination of pregnancy?
Abortion is legal in Great Britain if two doctors decide in good faith that in relation to a particular pregnancy one or more of the grounds specified in the Abortion Act are met
They must make their practice aware of the conscientious objection prior to meeting the patient.
If they happen to see a patient asking for a termination of pregnancy, they must refer them to a different doctor within a reasonable amount of time.
Everybody over 20 weeks of pregnancy in Scotland would have to travel to England where 24 weeks is in England – healthboards pay for this
In abortions carried out after 21+6 weeks, what has to be done?
If the abortion is carried out after 21+6 weeks, have to put potassium chloride into babies heart to drive the baby into asystole to ensure there is not a live abortion
(Pic is from royal college of obstetrics and gynaecology)
What circumstance is only one doctors signature required to carry out an abortion?
IF there is an emergency or to save the patients life, then only one medical doctor is required
