Unplanned Pregnancy

Question 1

What percentage of pregnancies are unintended at conception?

Answer 1

30-50%

Question 2

How many women die due to unsafe abortions?

Answer 2

8 per hour

Question 3

What is the most recent law regarding abortion in Scotland?

Answer 3

Human Fertilisation and Embryology Act 1990

Question 4

Is abortion legal?

Answer 4

It remains illegal but there are exceptions to this act

Question 5

Name the abortion documentation

Answer 5

Cerficate A/HSA1

Question 6

Describe the documentation of abortion

Answer 6

2 doctors sign under one of 7 specific causes (5 are signed by two doctors, 2 are signed by one doctor in an emergency)

Question 7

Who must any abortion be reported to?

Answer 7

HSA4 to regional CMO

Question 8

What clause are most abortions signed under?

Answer 8

Clause C - continuing the pregnancy would involve risk of injury to the physical/mental health of the women or her existing children/family

Question 9

What is the gestational limit on clause C?

Answer 9

24 weeks

Question 10

What clause is the second most used?

Answer 10

Clause E - substantial risk that if the child were born it would suffer physical/mental abnormalities as to be seriously handicapped

Question 11

What is the gestational limit of clause E?

Answer 11

No limit

Question 12

What is conscientious objection?

Answer 12

Right to refuse to be involved in care

Question 13

State the three limits of conscientious objection

Answer 13

• does not apply in emergency/life threatening situation
• should not delay/prevent access to care
• does not apply to ‘indirect’ tasks associated with abortion e.g administrative/supervision of staff

Question 14

How can a woman access abortion services?

Answer 14

• GP
• Self -referral
• Sexual Health Clinic

Question 15

How soon after referral will a woman be seen?

Answer 15

<5 days

Question 16

After their initial consultation how soon will a procedure occur?

Answer 16

<2 weeks

Question 17

What changes have been made in abortion services as a result of COVID?

Answer 17

• Mifepristone licensed for home administration
• Home abortion up to 11+6 weeks
• Select cases can proceed without ultrasound
• No routine swab/blood test

Question 18

How is gestation calculated?

Answer 18

Estimated LMP +/- date of positive pregnancy test
Palpable uterus suggests >12 weeks
Abdominal or transvaginal US (<6 weeks)

Question 19

Name three circumstances where a woman would be given an ultrasound during COVID

Answer 19

• symptoms/risk of ectopic pregnancy
• uncertainty of dates
• before STOP in some areas

Question 20

What is the medical management of abortion <12 weeks?

Answer 20

Mifepristone and misoprostol at home, requires second half dose of misoprostol if >10 weeks or no bleeding within four hours

Question 21

What is the medical management of abortion >12 weeks?

Answer 21

Inpatient, mifepristone followed by repeated IV doses of misoprostol (800mg then 400mg 3 hourly up to four times)

Question 22

What type of drug is mifepristone?

Answer 22

Oral, anti-progesterone

Question 23

What type of drug is misoprostol?

Answer 23

Prostaglandin that opens and softens the cervix

Question 24

How do mifepristone and misoprostol work together?

Answer 24

Together cause the uterus to contract, the cervix to open and passage of pregnancy tissue - usually after an hour of misoprostol bleeding which increases over a few hours to cramps until tissue passes

Question 25

In Scotland when is a medical abortion available until?

Answer 25

19+6 weeks | >20 weeks requires travel to England

Question 26

What is a contraindication for an at home abortion?

Answer 26

Not recommended for those under 16 years old

Question 27

What does a EMAH pack contain?

Answer 27

``` Mifepristone Misoprotol Anti-emetic Analgesia Antibiotics (doxycycline 7 day course) Contraception - 6/12 POP Contact leaflet and low sensitivity pregnancy test (2 weeks) ```

Question 28

Before surgical abortion what must be done?

Answer 28

Cervical priming via misoprostol or osmotic dilators

Question 29

What are osmotic dilators?

Answer 29

Place in cervical canal for a few hours, absorb fluid and the pressure encourages the cervix to open up

Question 30

Describe surgical abortion <14 weeks

Answer 30

Electric vacuum aspiration - GA | Manual Vacuum aspiration - up to 10 weeks- LA

Question 31

Describe surgical abortion >14 weeks

Answer 31

Dilatation and evacuation requires travel to england

Question 32

State the complications associated with abortion

Answer 32

``` Haemorrhage/need for transfusion Failed/incomplete Infection Uterine perforation Cervical trauma ```

Question 33

Describe rhesus iso-immunisation

Answer 33

Rhesus negative women an abortion may be a sensitising event - foetal cells containing D antigen access maternal circulation and create anti-bodies that can destroy a future rhesus positive baby. Anti-D Ig given to rhesus negative women.

Question 34

Describe VTE prophylaxis

Answer 34

Physiological changes in the coagulation system occur in pregnancy and increase background risk. Risk assessment - high risk given LMWH for 1 month after abortion and if very high it is continued fo 6 months

Question 35

How many women experience a repeat abortion?

Answer 35

1 in 3

Question 36

How soon after abortion does a woman's fertility return?

Answer 36

Ovulation occurs within the first month in >90% of women and at least 50% will resume sexual activity in 2 weeks

Question 37

How soon after abortion should contraception be started?

Answer 37

Immediately/within 5 days to ensure it is effective straight away - if not use condoms for bridging period

Question 38

What is the recommended form of contraception after abortion?

Answer 38

Long Acting Reversible Contraceptives

Question 39

When should IUD be avoided?

Answer 39

Presence of infection

Question 40

When should the diaphragm be avoided?

Answer 40

If 2nd trimester TOP as will need to wait for normal anatomy to return and be refitted