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Reproduction > Unplanned Pregnancy > Flashcards

Unplanned Pregnancy Flashcards

1
Q

what % of all pregnancies are unintended at conception?

A

30-50%

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2
Q

what is a HSA1 (certificate A) form and who is required to sign?

A

form stating the reasons for termination

2 doctors required to sign

*5 clauses - A to E

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3
Q

when would a HSA1 form be carried out?

A

in an emergency abortion - must be completed within 24 hours of emergency abortion

*clauses F&G

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4
Q

what is a HSA4 form?

A

notification for the CMO - must be completed by doctor and sent to chief medical officer within 7 days of abortion taking place

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5
Q

for the grounds of termination, what do the clauses A to E state?

A 
A = continuance of pregnant involve risk of life to pregnant woman greater than if terminated 
B = termination necessary to prevent permanent injury to physical / mental health 
C = pregnancy hasn't exceeded 24 weeks and would involve risk to injury of physical or mental health or woman 
D = same as above but would involve risk to existing children 
E = there is risk that if child were born, it would suffer from physical or mental abnormalities as to be seriously handicapped
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6
Q

for the grounds of termination, what to clauses F and G state?

A 
F = it was necessary to save life of woman 
G = it was necessary to prevent grave injury to physical or mental health of pregnant woman
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7
Q

under what clause are most terminations certified under?

A

clause C (98%) = pregnancy has not exceeded its 24th week and continuance of pregnancy would involve risk of injury to physical or mental health of pregnant women

*next common is E - no gestational limit

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8
Q

what are the limitations of conscientious objection (1967 abortion act allowing HCPs the right to refuse to participate in abortion care)?

A

does not apply in emergency or life-threatening situations

should not delay or prevent access to care

does not apply to “indirect” tasks associated with abortion (eg admin, supervision)

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9
Q

what is the waiting time between referral time by GP or SRH and the procedure?

A

<5 days between referral and consultation

<2 weeks between referral and procedure (in SRH or gynaecology)

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10
Q

how can gestation be assessed clinically?

A

estimated by LMP +/- date of positive UPT

palpable uterus - seen after 12 weeks (if no palpable uterus then probably in 1st trimester)

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11
Q

what is most commonly used to confirm gestation and what are the two types of this?

A

ultrasound

abdominal and transvaginal (<6 weeks)

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12
Q

what two medications are involved in a medical abortion?

A

mifepristone 200mg PO (anti-progesterone)

misoprostol 800mcg - 4 x 200mcg PV / SL (24-48 hours later)

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13
Q

medical abortions below which week gestation can be carried out at home?

A

<10 weeks

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14
Q

what is the difference in dose of misoprostol in medical abortions >10 weeks (inpatient)?

A

misoprostol: 800mcg PV then 400mcg 3 hourly PV / PO / SL (up to 4)

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15
Q

up to which gestation is medical termination available in Scotland?

A

19+6 weeks

> 20 weeks require travel to England

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16
Q

early medical abortion at home is not recommended for who?

A

those under 16

those with clotting disorders, likelihood of complications, support at home, distance from hospital

17
Q

for a surgical abortion, what is used for cervical priming?

A

misoprostol or osmotic dilators

*this reduces complication rates

18
Q

how can a surgical abortion <14 weeks carried out?

A

electric vacuum aspiration (under GA)

manual vacuum aspiration (under LA, up to 10 weeks only)

19
Q

how is a surgical abortion >14 weeks carried out?

A

dilation and evacuation

20
Q

surgical termination of pregnancy is not available >14 weeks in scotland - true or false?

A

true (usually not much past 12 weeks)

*would need to travel to specialist surgeons in England

21
Q

abortion is a relatively safe procedure - true or false?

A

true

*complications generally increase with increasing gestation but still rare

22
Q

what are the possible complications of abortion?

A

haemorrhage (severe bleeding requiring transfusion rare, higher in SToP)

failed / incomplete abortion (higher if mifepristone / misoprostol administered on same day)

infection (lowest for early)

uterine perforation (SToP only) = lower for early abortions

cervical trauma (SToP only) = lower for early abortions, reduced with cervical priming

23
Q

who is given antibiotic prophylaxis at time of abortion?

A

those undergoing SToP

those undergoing MToP with increased risk of STI

24
Q

what antibiotic prophylaxis is given at time of abortion?

A

doxycycline 100mg BD 7 days
or
azithromycin 1g + 500mg OD for 2 days

25
Q

how can rhesus sensitising event be prevented?

A

by administration of anti-D Ig to at risk Rhesus -ve mothers

*if not given, can lead to development of anti-D antibodies which can cross placenta in future pregnancies and destroy Rh+ve foetal RBC

26
Q

for those at risk of VTE, what prophylaxis can be given?

A

high risk = consider LMWH 1 week after abortion

very high risk = consider starting LMWH before abortion and continue longer

27
Q

what type of contraception is recommended after abortion?

A

implant, copper coil and hormone coil

28
Q

almost all methods of contraception can be started at / soon after abortion - when is it effective?

A

immediately if started on the day of abortion (or within 5 days)

if started after 5 days, efficacy depends on method

  • POP (2 days)
  • CHC / DMPA / SDI / LNG-IUS (7 days)
29
Q

when is it not recommended to put a coil in?

A

endometriosis or sepsis post-abortion

30
Q

women should avoid FAM (fertility awareness method) until when?

A

regular menstruation occurs

31
Q

when can intra-uterine methods of contraception (LNG-IUS or Cu-IUD) be inserted?

A

immediately after SToP or MToP once expulsion of pregnancy is confirmed

32
Q

when can hormonal methods of contraception (CHC, SDI, DMPA, POP) be used?

A

started any time after MToP or SToP including day of mifepristone / misoprostol

33
Q

when can non-hormonal methods of contraception be used?

A

barrier methods can be used anytime (except diaphragm after 2nd trimester TOP)

sterilisation after some time has elapsed (risk of failure and regret)

avoid FAM until regular periods resume

34
Q

what follow up should take place after early medical termination at home?

A

low sensitivity UTP performed at least 2 weeks after abortion (not standard UPT - these can show elevated hCG up to 4-6 weeks after procedure)

this is to identify incomplete or failed procedure

*if +ve then invited back for US - if some left can be managed conservatively or surgically

Reproduction (45 decks)

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