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Reproduction > Week 2- unplanned pregnancy and sexual health clinic > Flashcards

Week 2- unplanned pregnancy and sexual health clinic Flashcards

1
Q

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

A

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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2
Q

Describe the abortion acts rules briefly

A

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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3
Q

What is meant by conscientious objection?

A

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

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4
Q

Can you conscientiously object in an emergency?

A

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

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5
Q

What occurs in a termination of pregnancy appointment?

A

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

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6
Q

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

A

23 weeks and 6 days

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7
Q

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

A

Up to any gestation.

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8
Q

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

A

Medical termination is allowed up to 18 weeks and 6 days

Surgical termination is allowed up to 12 weeks

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9
Q

What is the process of medical termination of pregnancy?

A

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

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10
Q

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

A

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

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11
Q

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

A

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

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12
Q

What two surgical abortion procedures are available?

A

Vacuum aspiration

Dilatation and evacuation

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13
Q

When can vacuum aspiration be performed?

A

6-12 weeks.

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14
Q

When can you perform dilatation and evacuation?

A

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

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15
Q

Is there any preparatory treatment needed before a surgical TOP?

A

Need vaginal prostaglandins

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16
Q

Can vacuum aspiration be performed under local anaesthetic?

A

Yes.

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17
Q

What procedural risks are associated with surgical termination of pregnancy?

A 
Haemorrhage 
Pain
Infection
Incomplete/failed procedure
Uterine perforation
Cervical trauma
Ongoing pregnancy
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18
Q

Is there any follow up required after surgical TOP?

A

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

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19
Q

When is emergency contraception needed?

A

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

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20
Q

What are the methods of emergency contraception?

A

Intrauterine- copper IUD

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

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21
Q

How do the oral emergency contraception pills work?

A

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

22
Q

When are the emergency contraceptions affective in the menstrual cycle?

A

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

23
Q

When would you avoid using Ellaone over levonorgestrel?

A

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.

24
Q

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

A

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

25
Q

When can you fit the IUD after unprotected sex?

A

Up to 120 hours post UPSI.

Up to 5 days after expected earliest date of ovulation.

26
Q

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

A

Before.

27
Q

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

A

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.

28
Q

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

A 
History- UPSI, menstrual cycle, PMH/DH
Contraception- current, past and future
STI risk assessment and screening
Discussion and provision of chosen method 
Aftercare advice
29
Q

What is the ‘look back’ period in STIs?

A

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

30
Q

What is the look back period for gonorrhoea?

A

Male urethral- 2 weeks

Any other form- 3 months

31
Q

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

A

4 weeks

32
Q

What is the look back period for trichomonas vaginalis?

A

4 weeks

33
Q

What is the look back period for epidydimitis?

A

If due to chlamydia or gonorrhoea- 6 months

34
Q

What is the look back period for pelvic inflammatory disease?

A

If due to chlamydia or gonorrhoea- 6 months.

35
Q

What is the look back period chlamydia?

A

Male urethral- 2 weeks

Any other- 6 months.

36
Q

What is the look back period for HIV?

A

Look back 4 weeks before negative test.

37
Q

What is the look back period for syphillis?

A

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

38
Q

Partner notification is not needed for?

A

Warts
Thrush
Bacterial vaginosis
Herpes

39
Q

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

A

Work with the patient- it must be voluntary.

Could be done face to face or over the phone

40
Q

Who gets hepatitis B vaccinations?

A

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

41
Q

Who gets HPV vaccinations?

A

Men who have sex with men

42
Q

What is PreP?

A

Medication before exposure to reduce risk of infection.

43
Q

What is PEPSE?

A

Medication taken after exposure to reduce the risk of infection.

44
Q

Give examples of PEPSE?

A

Hepatitis B- up to 7 days after exposure.

HIV- 3 anterovirals. Start within 72 hours. 28 days total.

45
Q

Define rape

A

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

46
Q

When is consent invalidated?

A

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

47
Q

What is the immediate management of rape?

A 
Make sure the patient is safe
Consider forensic examination
Injuries
HBV vaccination
Consider PEPSE
STI/pregnancy care
48
Q

What is the medium- long term management of rape?

A 
Screen for STIs
Assessment of coping abilities 
PTSD
HBV vaccines 
Practical and psychosocial support.
49
Q

Give some examples of gender based violence?

A 
Domestic abuse
Rape or sexual assault
Childhood sexual assault
Commercial sexual exploitation
Stalking/harassment 
Harmful traditional practices.
50
Q

What are the risk factors for gender based violence?

A

Main one- is being female

Other factors may also increase vulnerability- Disability, pregnancy, addictions, HIV

Reproduction (34 decks)

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