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Part 1 MFSRH 2024 > Abortion Care > Flashcards

Abortion Care Flashcards

1
Q

What type of drug is mifepristone?

A

Competitive progesterone receptor antagonist

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2
Q

What is the mechanism of action of mifepristone?

A
  • Inhibits progestogenic effects on the endometrium and myometrium
  • Degeneration of the decidual endometrium (which can cause detachment of the trophoblast and reduced synthesis of bHCG by the syncytiotrophoblast)
  • Cervical softening and dilatation
  • Increases contractility of myometrium and its sensitivity to prostaglandins
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3
Q

What proportion of women experience vaginal spotting after mifepristone?

A

50%

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4
Q

What type of drug is misoprostal?

A

A prostaglandin E2 analogue

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5
Q

What is the mechanism of action of misoprostal?

A

Uterotonic/cervical ripening:
- Collagenase activation causing collagen breakdown within the cervical stroma

  • Myometrial smooth muscle contraction
  • Reduction in cervical tone
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6
Q

What is the upper limit for home administration of misoprostal in England?

A

11+6/40

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7
Q

What proportion of women will have a TOP in the UK within 1 year postnatally?

A

1 in 13

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8
Q

What plane should be used in taking a HC measurement?

A

Transthalamic plane

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9
Q

How many unsafe abortions occur each year?

A

25 million

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10
Q

What proportion of women will get nausea, vomiting,
diarrhoea, chills and fever with miso?

A

1 in 10

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11
Q

What is the risk of continuing pregnancy with abortion?

A

Medical abortion - 1 in 200
Surgical abortion - 1 in 1000 (higher in pregnancies <7 weeks)

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12
Q

What is the risk of needing further intervention to complete the abortion procedure?

A

Medical abortion:
<14 weeks: 70 in 1000
>14 weeks: 13 in 100

Surgical abortion:
<14 weeks: 35 in 1000
>14 weeks: 3 in 100

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13
Q

What is the risk of infection with abortion?

A

1 in 100

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14
Q

What is the risk of severe bleeding requiring transfusion after an abortion?

A

1 in 1000

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15
Q

What is the risk of cervical injury with a surgical abortion?

A

1 in 100

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16
Q

What is the risk of uterine perforation with a surgical abortion?

A

1-4 in 1000

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17
Q

What is the risk of uterine rupture in 2nd trimester medical abortion?

A

<1 in 1000

18
Q

In what conditions is there a theoretical risk associated with mifepristone (consider miso only abortion)?

A
  1. Severe uncontrolled asthma
  2. Chronic adrenal failure
  3. Inherited porphyria
19
Q

What is the concern regarding LONG TERM steroid use and medical abortion?

A

Since mifepristone is a glucocorticoid receptor antagonist, it might inhibit the action of the steroid therapy and exacerbate the
underlying condition

20
Q

What antibiotic regime can be considered for prophylaxis following STOP?

A

Oral doxycycline 100mg twice a day for 3 to 7 days, starting within 2 hours of the procedure
(there is evidence that a 3-day course is as effective as a 7-day course)

21
Q

How can an EMAH be confirmed successful?

A

With either a low-sensitivity urine pregnancy test (detection limit 1000IU hCG) from 2 weeks after
treatment or with a high-sensitivity test (detection 50IU hCG or less) from 4 weeks after treatment

22
Q

What are the recommended timescales for treatment (RCOG)?

A

Abortion services must offer assessment within 5 days
Should offer the procedure within 5 days of the decision to proceed

For NICE it is 7 days for each

23
Q

When should feticide be performed?

A

From (and including) 22+0 gestation to prevent live birth

24
Q

Does paracetamol reduce pain in abortion?

A

Oral paracetamol has not been shown to reduce pain more than placebo during medical
abortion and is not recommended

25
Q

How long should a HSA1 (Certificate A in Scotland) be kept for?

A

3 years

26
Q

Does a HSA2 require a 2nd signature?

A

No
Must be completed within 24 hours of an emergency abortion
Must be kept for 3 years

27
Q

How long before the HSA4 (England) needs to be sent?

A

Sent to the CMO within 14 days of the abortion taking place

28
Q

How long before the Notification Form (Scotland) needs to be sent?

A

Sent to the CMO within 7 days of the abortion taking place

29
Q

What proportion of abortions are carried out under Ground C?

A

97%

30
Q

What is the maternal mortality rate associated with abortion? (UK 2006-08)

A

0.32/100 000 maternities

31
Q

What is the maternal mortality rate? (UK 2006-08)

A

11.39/100 000 maternities

32
Q

What proportion of women are still bleeding 2 weeks after their medical TOP?

A

22% (greater chance the greater the gestation)

33
Q

What proportion of women <24 currently have CT?

A

5-10%

34
Q

What is the superior dilator at 14+0 gestation?

A

Osmotic dilators
Although mife may be used up to 18+0

35
Q

At what abortion gestation should anti-D be offered (NICE)?

A

10+0 gestation+

36
Q

What medication regime should be offered between 25 and 26 weeks?

A

200 mg oral mifepristone, followed by 400 micrograms misoprostol (vaginal, buccal or sublingual) every 3 hours until delivery

37
Q

What medication regime should be offered between 25+1 and 28 weeks?

A

200 mg oral mifepristone, followed by 200 micrograms misoprostol (vaginal, buccal or sublingual) every 4 hours until delivery

38
Q

What medication regime should be offered after 28 weeks?

A

200 mg oral mifepristone, followed by 100 micrograms misoprostol (vaginal, buccal or sublingual) every 6 hours until delivery

39
Q

What proportion of pregnancies end in abortion in the UK?

A

25%

40
Q

Which part of The Abortion Act cover conscientious objection?

A

Section 4

41
Q

Which act covers selective reduction of multiple pregnancy?

A

Human Fertilisation and Embryology Act 1990

Part 1 MFSRH 2024 (20 decks)

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