Unplanned Pregnancy Flashcards
(44 cards)
How common are unplanned pregnancies?
30-50% of all pregnancies are unintended at conception = may be unplanned or mistimed
What are some of the poorer outcomes associated for mother and baby associated with unplanned pregnancy?
Later initiation and less frequent antenatal care
Increased preterm birth and low birthweight
Increased postnatal depression and substance abuse
Reduced breastfeeding and bonding with infant
Increased rates of child neglect and abuse
How common are abortions?
30-40% of unintended pregnancies end in abortion
Unsafe abortions account for 8 deaths per hour
What are some of the laws surrounding abortion?
Abortions Act 1967 = permits abortions in Scotland, England and Wales
What is the legislation around in abortions in Northern Ireland?
Used to only be permitted to prevent death or serious long term harm to mother = legislation changed in March 2020
How are abortions documented?
Certified under specific indication = 5 clauses A-E
Certified on HSA1 form = signed by 2 doctors
Two emergency clauses (F & G0) = one doctor signs (HSA2)
Who must all abortions be reported to?
The Chief Medical Officer = via abortion notification form (HSA4)
What are the most common certification of abortion in the UK?
98% are clause C = has gestational limit of 24 weeks
1-2% are clause E = has no gestational limit
What conditions does clause C allow abortions under?
If continuing the pregnancy would involve risk of injury to the physical or mental health of the mother or her family
What conditions does clause E allow abortions under?
If there is substantial risk that the child would be severely handicapped
What is the legislation applies to conscientious objection?
Clause within Abortion Act 1967 that allows health care professionals the right to refuse to participate in an abortion
What situations does conscientious objection to abortion not apply?
Doesn’t apply in emergency/life threatening situations
Shouldn’t delay or prevent patient’s access to care
Doesn’t apply to indirect tasks associated with abortion (e.g admin)
Who can refer a patient for an abortion?
Either via GP or SRH
Self-referral becoming more available
Where do abortion consultations take place?
In the SRH or in gynaecology setting
What are the target windows for seeing a patient that wants an abortion?
Aim <5 days between referral and consultation
Aim <2 weeks between referral and procedure
How can you assess the gestation of a pregnancy?
Clinical = estimated by LMP +/- date of positive UPT, palpable uterus >12 weeks US = frequently used to confirm gestation, abdominal or transvaginal (<6 weeks)
What does medical abortion (MTOP) involve?
Two medications = mifepristone 200mg PO, misoprostol 800mcg PV/SL (24-48 hrs later)
How is a medical abortion carried out <10 weeks gestation?
Called early medical abortion at home (EMAH) = can self administer misoprostol at home
How is a medical abortion carried out >10 weeks gestation?
Inpatient procedure = repeated dose of PV misoprostol
800mcg PV then 400mcg every three hours PV/PO/SL (up to four doses)
What gestation are MTOP offered up until in Scotland?
Available up to 19+6 weeks in most areas = once >20 weeks requires travel to England (BPAS)
Which age group are early medical abortions at home not recommended in?
Those aged <16 years old
What is given before surgical abortion?
Cervical priming via misoprostol or osmotic dilators
What surgical abortion methods are available before 14 weeks gestation?
Electric vacuum aspiration = general anaesthesia
Manual vacuum aspiration = up to 10 weeks, local anaesthetic
What surgical methods are available after 14 weeks gestation?
Dilation and evacuation
