TOP/PUL counselling

Question 1

potential causes of early bleeding

Answer 1

viable pregnancy where symptoms can resolve
miscarriage
ectopic pregnancy

Question 2

Ix following early bleeding

Answer 2

abdominal & vaginal USS
bloods // bHCG

Question 3

Outpx Mx of PUL // suspected miscarriage

Answer 3

serial bHCG (eg now v 48hrs later)
viable preg - double (66%)
ectopic - stay same // rise slightly
miscarriage - fall
molar pregnancy - rise significantly

if ectopic suspected –> repeat USS 7-14 days (or sooner) to determine location

Question 4

safety netting in early bleeding // suspected ectopic//miscarriage

Answer 4

contact EPAU/A&E if:
severe pain in abdomen, heavy bleeding, pain in shoulder tip, dizziness, fainting

Question 5

Termination occurs between what weeks?

Answer 5

0-24

Question 6

What 2 medical drugs are given in termination?

Answer 6

Misoprostol

Mifepristone

Question 7

How do the medical drugs work in termination?

Answer 7

Relax cervix

Soften cervix

Stimulate contractions for expulsions

Question 8

What do we also need to give patients if the termination occurs 10+ weeks

Answer 8

Anti-D Rhesus injection
–> if woman wants to be pregnant again

Question 9

Describe the Surgical Management of Termination

Answer 9

Same medical drugs + Anaesthetics (GA / Local) + Osmotic dilator to open cervix + Suction / Evacuation w/forceps

Question 10

If 0-14 weeks TOP, what is the surgical management of termination?

Answer 10

Cervix dilation + Suction concents

Question 11

If 14-24 weeks TOP, what is the surgical management of termination?

Answer 11

Cervix dilation + Evacuation w/forceps

Question 12

What complication can occur from termination?

Answer 12

Vaginal bleeding + Pain for 2weeks

Question 13

What to offer to patients if they don’t want to come to the hospital + <10weeks? Termination

Answer 13

Marie Stopes

Can give medication sent to home

Question 14

What do we need to do before surgical /medical management is done for termination?

Answer 14

Ultrasound
Blood tests
Pregnancy test

Question 15

How do we confirm that abortion is complete? (2)

Answer 15

No sex for 3 weeks
Test Pregnancy test 3-4 weeks (preg. tests become reliable 2 weeks after abortion)

Question 16

What do we advise to patients who have just had an abortion? (3)

Answer 16

Marie Stopes advice

Contraception discussion for future

expect continued bleeding for up to 6 weeks

Question 17

safety net for symptoms of

Answer 17

retained products

PID

Question 18

mx options following ectopic

Answer 18

medical - methotrexate injection
- only advised if the pregnancy is very early.
- need close observation for several weeks, repeated blood tests and scans
- hCG checked every 2-3 days until the levels are low.
- side-effects include nausea and vomiting, abdominal pains

Wait and see if not life threatening – may resolve by self (similar to miscarriage).

If Rhesus negative, need anti-D immunoglobulin prevents production of antibodies

Question 19

what if <16 wants abortion

Answer 19

need form signed by 2 doctors

Question 20

tests prior to abortion

Answer 20

chlamydia
HepB // HIV
Rh state
Hb, blood type
cervical screen

Question 21

contraindications medical abortion

Answer 21

> 35 & smoker
ectopic pregnancy
heart disease
high blood pressure
liver/kidney disease
adrenal failure
anticoagulants