Week 2- unplanned pregnancy and sexual health clinic Flashcards by Mhairi Allison

If you find you are pregnant, what are your options?

Continue with the pregnancy and keep the child
Continue with the pregnancy and put the child up for adoption
Terminate the pregnancy.

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Describe the abortion acts rules briefly

Abortion must be certified by two registered medical practitioners
Has to be carried out in an NHS hospital
Only a registered medical practitioner can carry out the abortion process.

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What is meant by conscientious objection?

When you can’t perform a procedure because it goes against your moral/religious beliefs you can opt out.

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Can you conscientiously object in an emergency?

Nope- in the event of an emergency the treatment cannot be objected against.

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What occurs in a termination of pregnancy appointment?

Discuss certainty to proceed and alternative
Ultrasound- determine IUP and gestation
Complete medical history
Methods of TOP

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At what week can you terminate a pregnancy up till for social reasons?

23 weeks and 6 days

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At what week can you terminate a pregnancy for foetal abnormalities?

Up to any gestation.

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How does the termination of pregnancy dates differ in NHS tayside?

Medical termination is allowed up to 18 weeks and 6 days

Surgical termination is allowed up to 12 weeks

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What is the process of medical termination of pregnancy?

2 pills are given
The first is oral mifepristone 200mg (anti-progesterone).
Then you give prostaglandin pessary e.g. misoprostal.

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If you are in the early stages of pregnancy (less than 9 weeks), how may your medical abortion management differ?

You will be given the option to carry out the second part of the abortion at home.

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If you are in the later stages of early pregnancy (9-24weeks), how may your medical abortion management differ?

You may need repeated doses of the prostaglandin 3 hourly (maximum is 5 doses over 24 hours)

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What two surgical abortion procedures are available?

Vacuum aspiration

Dilatation and evacuation

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When can vacuum aspiration be performed?

6-12 weeks.

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When can you perform dilatation and evacuation?

13-24 weeks (however not available in Scotland).

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Is there any preparatory treatment needed before a surgical TOP?

Need vaginal prostaglandins

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Can vacuum aspiration be performed under local anaesthetic?

Yes.

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What procedural risks are associated with surgical termination of pregnancy?

Haemorrhage 
Pain
Infection
Incomplete/failed procedure
Uterine perforation
Cervical trauma
Ongoing pregnancy

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Is there any follow up required after surgical TOP?

Pregnancy test usually 2-3 weeks after.
Anti-d therapy
Contraception.

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When is emergency contraception needed?

When contraception hasn’t been used
When contraception has failed
In the period before other contraception becomes effective.

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What are the methods of emergency contraception?

Intrauterine- copper IUD

Oral- levonorgestrel-3days or Ullipristal acetate (ellaone)- 5 days

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How do the oral emergency contraception pills work?

They delay ovulation- one is an anti progesterone (Ella one) and one is a high dose progesterone (levonorgestrel)

When are the emergency contraceptions affective in the menstrual cycle?

Levonorgestrel is affective until the LH surge
Ellaone is affective before this and during the LH surge.
Neither of them work after ovulation.

When would you avoid using Ellaone over levonorgestrel?

If wishing to ‘quick start’ hormonal contraception
Must delay ongoing contraception for 5 days
If hormonal contraception has been used in the last 7 days
If patient has severe acute asthma uncontrolled by inhaled steroids.

What is more effective- the IUD or the oral emergency contraception?

The copper coil is 10 x more effective than the oral pills.

When can you fit the IUD after unprotected sex?

Up to 120 hours post UPSI. | Up to 5 days after expected earliest date of ovulation.

Should you screen/test women for STI's before or after insertion of the copper IUD?

Before.

A pregnancy doesn't implant 5 days post fertilisation. True or false?

True. This Is why the copper coil can be fitted up until 5 days after unprotected sex or ovulation. On day 1- the egg has to be fertilised as it only survives for 24 hours. It normally implants on day 6. So the copper coil has 5 days to do its thang before implantation occurs.

In an emergency contraception consultation, what areas should you cover?

``` History- UPSI, menstrual cycle, PMH/DH Contraception- current, past and future STI risk assessment and screening Discussion and provision of chosen method Aftercare advice ```

What is the 'look back' period in STIs?

How far you should you back to assess which partners are at risk.

What is the look back period for gonorrhoea?

Male urethral- 2 weeks | Any other form- 3 months

What is the look back period for non-specific urethritis?

4 weeks

What is the look back period for trichomonas vaginalis?

4 weeks

What is the look back period for epidydimitis?

If due to chlamydia or gonorrhoea- 6 months

What is the look back period for pelvic inflammatory disease?

If due to chlamydia or gonorrhoea- 6 months.

What is the look back period chlamydia?

Male urethral- 2 weeks | Any other- 6 months.

What is the look back period for HIV?

Look back 4 weeks before negative test.

What is the look back period for syphillis?

Primary- 90 days Secondary- 2 years Other infections- 3 months before most recent negative test.

Partner notification is not needed for?

Warts Thrush Bacterial vaginosis Herpes

How can you get a patient to do a partner notification?

Work with the patient- it must be voluntary. | Could be done face to face or over the phone

Who gets hepatitis B vaccinations?

Men who have sex with men High prevalence countries Contact- e.g. health professionals Sexual assault.

Who gets HPV vaccinations?

Men who have sex with men

What is PreP?

Medication before exposure to reduce risk of infection.

What is PEPSE?

Medication taken after exposure to reduce the risk of infection.

Give examples of PEPSE?

Hepatitis B- up to 7 days after exposure. | HIV- 3 anterovirals. Start within 72 hours. 28 days total.

Define rape

Penetration of the vagina, anus or mouth by a penis without consent.

When is consent invalidated?

Incapacitated by alcohol or drugs Incarcerated (inprisoned or confined) Violence or threat of violence

What is the immediate management of rape?

``` Make sure the patient is safe Consider forensic examination Injuries HBV vaccination Consider PEPSE STI/pregnancy care ```

What is the medium- long term management of rape?

``` Screen for STIs Assessment of coping abilities PTSD HBV vaccines Practical and psychosocial support. ```

Give some examples of gender based violence?

``` Domestic abuse Rape or sexual assault Childhood sexual assault Commercial sexual exploitation Stalking/harassment Harmful traditional practices. ```

What are the risk factors for gender based violence?

Main one- is being female | Other factors may also increase vulnerability- Disability, pregnancy, addictions, HIV