15, F, pregnant and wants abortion

Question 1

15, F
+ve pregnancy test 4 days ago, wants abortion
LMP: 10 weeks ago, regular usually
sleeps around, uses condoms, has forgotten recently
ICE: parents will kill her, will ruin her life

DIFFERENTIALS

Answer 1

Dx: termination of pregnancy

Question 2

15, F
+ve pregnancy test 4 days ago, wants abortion

INVESTIGATIONS

Answer 2

Bedside:
1) Abdo exam - check how far pregnancy looks (may be underestimating it)
2) Urine pregnancy test

Bloods:
1) bHCG

Imaging:
1) USS - check pregnancy + how far it is

Question 3

15, F
+ve pregnancy test 4 days ago, wants abortion

COUNSELLING

Answer 3

• Thank you for telling me
• I’d like to confirm pregnancy with urine and blood and USS
• Unplanned pregnancy - want to talk to you about different options
• Will also give you leaflets you can take away with all info
• Ask if also ok to talk to parents
• Would recommend that you talk to partner, family, charities such as BPAS (British Pregnancy Advisory Service), Marie Stopes etc. to help decide
• May need to make safeguarding referral since you are below 16, they will not tell your parents without asking you first

Question 4

15, F
+ve pregnancy test 4 days ago, wants abortion

MANAGEMENT

Answer 4

Medical:
1) MIFEPRISTONE (200mg, oral) + MISOPROSTOL (800mg vaginal, buccal, sublingual) (24/48h later, can be at home) - up to 14 weeks (for later abortions (9-14w) miso can be given every 3 hours after first dose until abortion occurs)
+ FETACIDE (KCl injection into heart of baby to stop it) if >22 weeks
2) Bloods: Hb, G&S, Rhesus status - if Rhesus -ve, give anti-D (within 72h of TOP)
3) STI SCREEN
4) PAIN MANAGEMENT
5) DISCUSS CONTRACEPTION

N.B. mifi = antiprogesterone, miso = prostaglandin

Surgical:
1) SUCTION ASPIRATION (7-13w)
2) DILATION AND EVACUATION (>13w) - dilate cervix 12-24h pre-op
3) ABX - doxy (200mg) / azithromycin (500mg) within 2h
4) PAIN MANAGEMENT
5) DISCUSS CONTRACEPTION

Question 5

15, F
+ve pregnancy test 4 days ago, wants abortion

MANAGEMENT - EXPLAIN TO PT

Answer 5

1) pregnancy test
2) USS
3) pain relief

Medical:
4) 1st pill in clinic
5) either 2nd appt 24-48h later or sent home with 2nd pill

Surgical:
4) Appt booked
5) LA - area numbed + some sedation (awake but relaxed) (GA can have but unusual)
6) Vacuum - 5-10 mins, go home same day
7) D&E - dilate several hours/day before, procedure 10-20 mins, home same day
N.B. need to bring adult with you

Both methods may have cramps, medical will also have heavy bleeding - use OC pain relief eg. ibuprofen + bring sanitary pads

Sex when you feel ready - CONTRACEPTION

SAFETY NET: ongoing symptoms: bleeding, severe pain, smelly discharge, temperature, signs of pregnancy call clinic 24h helpline or come in

Question 6

Risks/comps of abortion?

Answer 6

• Haemorrhage
• Infection
• Structural damage - uterine rupture/perforation, cervical trauma
• Failure
• Psychological impacts

Question 7

What role does the father have in an abortion?

Answer 7

None, doesn’t have to agree and doesn’t even have to know

Question 8

Upper limit for abortion in England?

Answer 8

24 weeks
HOWEVER abortions are legal past this limit if there is grave risk to the life of the
mum, evidence of severe fetal abnormality or risk of grave physical and mental injury to the
women

Abortion act - statutory grounds for termination of pregnancy