termination of pregnancy Flashcards
(51 cards)
abortion care methods available in 9+6
9+ 6 = 9 weeks and 6 days so 10 weeks
1. early medical abortion (MTOP) -
2. Manual Vacuum aspiration (MVA) -local procedure in clinic, local block on cervix , put a big syringe and use vacuum.
abortion care methods available upto 14 weeks
suction termination (STOP) - patient is asleep and vacuum out
abortion care methods available 15-18 weeks
dilation and evacuation - dilate the cervix
abortion care methods available 14-24 weeks
mid- trimester medical abortion - tablets
-in the second trimester
abortion care methods available in 19 -24 weeks
two stage surgical procedures
- dilate for 24hrs
-then put a tube and evacute
Patient had sex 2 weeks ago and had her period 3 weeks ago and has a positive pregnancy test so how is her pregnancy time calculated?
according to her last menstrual period (LMP) not when she last had sex so she is 3 weeks pregnant not 2 weeks.
What is term pregnancy?
37 to 42 weeks
first trimester?
upto 12 weeks
-miscarriages are high in this stage
second trimester?
12-28weeks
third trimester?
28/37-41
The trend in medical and surgical method over the years
surgical method declined around 2014 and medical method increased
surgical = increased surgical risks, after-care
=>more ‘natural’
=>no surgery or anesthesia needed
=>precieved to be less frightening
=>more privacy
=>shorter stay in hospital
=>simpler and faster
what medical abortion is appropriate for gestation under 9 weeks?
=> Mifepristone 200mg PO :
-competes with progesterone receptors
-progesterone receptors are where the villi of the placenta are intact if there is disconnection of the receptors, the placenta is separate, placenta is separate so fetus can’t develop
-24-36 hrs later give: MISOPROSTOL 800mcg PV
=> Misoprostol is a prostaglandin (which make uterus contract and cervix dialate)
=> so Mifepristone to separate placenta and Misoprostol to contract uterus
Suction termination
-in the past it was seen to be avoided before 7 weeks now done anytime upto 14 weeks
-cervical prep beneficial (dialating cervix by softening using prostaglandins) prior to suction termination
-safer under local anaesthesia than manual vacuum aspiration (MVA)
What are some immediate complications during termination?
-anesthetic
-uteriene perforation- 0.8/1000
-cervical tears
- primary haemorrhage
-uteriene rupture
-death - rare 0.6/1,000,000
What are complications after discharge during termination?
rare:
-retained products of conception ~1: 100
-secondary haemorrhage
-pelvic infection
-failed abortion
-ectopic pregnancy
Prevention of STIs
-screen all women - opt out policy
-chlamydia, gonorrhea, syphilis, HIV
-treat positives and contact tracing to screena dn treat partners of they too are infected
-this will help with impact on their health and future fertility
What are late complications during termination?
-tubal factor infertility
-screening and antibiotics - prevention
-rhesus iso-immunisation blood group and antiD administration
-psychological and psychosexual sequelae
-counselling support and options to patients
psychological sequalae
-regret and early distress
-continuation of problems present before abortion
-long term post abortion distress risk factors :
unsupportive partner
ambivalence before abortion
prior psychiatric history
considering abortion is wrong
Aftercare of induced abortion
-anti-D prophylaxis
-written information
-contact details for support
-STI services follow up
-contraception advice and provision
-follow up appointment within 2 weeks optional
Long acting reversible contraceptive (LARC)
-7% of women switched to LARC according to NICE guidelines
-method: IUD, IUS, hormonal injection
-NHS save £100 million through reducing unintended pregnancies by 73,000
£26.8m new funding for improved access to contraception declared by the public health minister
Doctors good medical practise:
-treatment must be based on clinical judgement of patients needs and the likely effectiveness of the treatment
-you must not allow views about patients lifestyle, culture, beliefs, race, colour, gender, sexuality, disability, age or social/economic status to prejudice treatment
-must not refuse or delay treatment because you believe the patients actions have contributed to their condition
legislation-1967/1990
=>1967; abortion act passed, introduced by David Steel in England, Wales and Scotland and came into effect in 1968
=>1990 ; human fertilisation and embryology Bill lowered the gestation limit for abortions from 28 weeks to 24 weeks(this is currently the viable age for fetus to survive outside mother’s womb.
Northern Ireland -2017
funding scheme introduced to provide funded abortions in England and Wales, for residents of Northern Ireland.
travel was also funded by government equalities office and HM treasury
2018 -misoprostol at home
-woman in Wales and England could take the 2nd pill (misoprostol) at home.
-This brought England and Wales in line with Scotland which allowed this from oct 2017 (lack of hospital links in rural area)