Unplanned Pregnancy

Question 1

30-50% of pregnancies in the UK are “unintended”. What does this mean?

Answer 1

unplanned OR mistimed

Question 2

What reasons are there for unintended pregnancies decreasing in more developed than developing areas?

Answer 2

Due to access to education on long acting contraceptives

Question 3

If a pregnancy is unplanned then it can occur in poorer outcomes for the child. TRUE/FALSE?

Answer 3

TRUE

• this is often because pre-conception counselling cannot take place to encourage mothers to stop smoking/drinking etc

Question 4

What percentage of unintended pregnancies undergo abortion?

Answer 4

30-40%

Question 5

What percentage of abortions in lower income countries are considered “unsafe”?

Answer 5

~50% unsafe => present significant risk to mother

Question 6

Are unsafe abortions more likely to occur in countries with lenient or strict laws on abortion?

Answer 6

Strict laws

Question 7

What country has recently had legislation passed in order to be included in the Abortion Act?

Answer 7

Northern Ireland

Scotland, England and Wales already included

Question 8

Explain who must sign the certificate of abortion in the UK

Answer 8

HSA1 form “Certificate A” - 2 Doctors must sign this
(Includes 5 clauses A-E for reason of abortion)

HSA2 form - includes Emergency Clauses - Signed by 2 Doctor when abortion is required to save mother’s life

Question 9

Who must be informed when an abortion is carried out in the UK?

Answer 9

Regional Chief Medical Officer

Question 10

What clause of the HSA1 “Certificate A” do most abortions come under in the UK?

Answer 10

Clause C (95% of abortions)
- would cause mother significant physical/mental distress to continue with the pregnancy

Question 11

1-2% of abortions come under another clause of the HSA1 “Certificate A”. Which clause is this?

Answer 11

Clause E

- termination due to genetic defects which will render the child physically/mentally unwell after birth

Question 12

Clause E of the HSA1 Abortion Certificate has no gestational limit. What does this mean?

Answer 12

Clause E can be used to terminate a pregnancy at any point during gestation

Question 13

What is “conscientious objection”?

Answer 13

• healthcare professional can decide that they dont wish to participate in abortion procedures/referrals
  HOWEVER:
• they have a duty to treat a patient in an emergency (e.g. if experiencing a PV haemorrhage)
• they must not delay care to patients e.g. pass on to a colleague for filing a referral etc

Question 14

How many abortions procedures happen annually in the UK?

Answer 14

> 200,000

- it is the most common gynaecological procedure

Question 15

Patients attending the abortion clinic are normally referred from where?

Answer 15

• GP

- sexual health clinic

Question 16

How much time should be between the referral to abortion services and the eventual consultation?

Answer 16

Aim for <5 days

Question 17

Where is the initial consultation regarding abortion held and how long between this and the eventual procedure?

Answer 17

• consultation in sexual health or gynaecological setting

- Aim for <2 weeks between consultation and procedure

Question 18

There has been a large fall in abortion rates in the under 20 years age group. Why do we think this is?

Answer 18

• due to aimed promotion of long acting contraceptive methods

Question 19

Are abortion rates higher in high or low socioeconomic areas?

Answer 19

2x higher abortion in lower income areas

Question 20

Before what week of gestation do most abortions occur in Scotland?

Answer 20

< 9 weeks

Question 21

What are the two main categories of abortion procedure in the UK?

Answer 21

Medical (tablets) vs Surgical

Question 22

What does the choice of abortion procedure depend on?

Answer 22

• gestation at time of abortion
• preference
• regional availability

Question 23

How can gestation be assessed to make a choice on abortion procedure?

Answer 23

Clinically:

• LMP and date of first positive pregnancy test
• Palpable uterus? (only present if >12 wks)

US Scan:
- abdominal or transvaginal

Question 24

Describe the medical abortion procedure

Answer 24

Mifepristone given orally (Priming agent)

Misoprostol (4 tabs vaginally/ sublingually 48hrs after)

Question 25

Which of the tablets involved in the medical abortion MUST be given on NHS premises?

Answer 25

Mifepristone must be given at NHS clinic

Misoprostol is now licensed for self-administration in the patients home (to prevent bleeding/ complications on transport home from clinic)

Question 26

What can help mifepristone and misoprostol to be more effective after 10 wks gestation?

Answer 26

Further misoprostol doses due to later gestation

Question 27

Medical abortion is only available for up to 20 weeks gestation in Scotland, however abortion is licensed up until week 24 in the UK. How can patients still have a medical abortion at >20 weeks?

Answer 27

Referred to services in England where the clinics will carry out medical abortions later than in Scotland

Question 28

What groups of patients are recommended to stay at hospital during and after their misoprostol dose?

Answer 28

• patients who live far away from the hospital (incase of complications)
• those at higher risks of complications in the first place
• patients under 16 years of age