Flashcards in Termination Of Pregnancy Deck (70)
What is termination of pregnancy?
A medically directed miscarriage prior to independent viability, using pharmacological or surgical means
What is termination of pregnancy commonly referred to as?
What is the standardised abortion rate for women aged 15-44 in the UK?
What % of abortions in the UK are carried out at under 13 weeks gestation?
What % of abortions in the UK are carried out under 10 weeks?
What % of abortions carried out in the UK were medical?
What law governs abortions in England, Scotland, and Wales?
The 1967 Abortion Act
What is the age limit for abortion under the 1967 abortion act?
What are the requirements for abortion under the 1967 abortion act?
Can only be performed when;
- Reduces risk to woman’s life
- Reduces risk to her physical or mental health
- Reduces risk to physical or mental health of her existing children
- Baby is at substantial risk of being seriously mentally or physically handicapped
How is it confirmed that the criteria for abortion is met under the 1967 abortion act?
2 medical practitioners must certify in good faith by signing from HSA1 that at least 1 of these criteria apply
Under which of the criteria of the 1967 abortion act are most abortions performed?
Criteria 2 (risk to physical or mental health)
When is there no upper limit on gestation under the 1967 abortion act?
- Risk to mother’s life
- Risk of grave, permanent injury to mothers physical/mental health
- Substantial risk that, if the child were born, it would have such physical or mental abnormalities as to be seriously handicapped
What are the usual scenarios for abortion after 20 weeks?
- Following amniocentesis
- In very young girls who have concealed or not recognised the pregnancy
How does the abortion law differ in Northern Ireland?
Abortion is unlawful other than in restricted circumstances
What do the GMC guidelines state regarding girls under 16 requesting an abortion?
Girls under 16 may be able to make an informed decision without parental consent if they are deemed to have the capacity to do so
When do GMC guidelines state that abortions can be provided to girls under 16 without parental knowledge?
- The girl understands all aspects of the advice and its implications
- You cannot persuade her to tell her parents, or to allow you to tell them
- It is in the best interests of the young person to receive the advice and treatment without parental knowledge and consent
Can the consent of a girl under 16 override parental refusal to allow abortion?
Yes, if they are competent
When can someone with parental responsibility consent for abortion on a girls behalf?
If they lack capacity
What should be done if someone is parental responsibility is consenting to abortion because the young person lacks capacity?
The views of the young person should be heard and taken into consideration
What should be considered in a person presenting for abortion when they are unable to consent?
Should consider possibility of sexual abuse - if young person does not have capacity to consent to abortion, do they have capacity to consent to sexual intercourse?
What is strongly advised regarding terminations in girls aged <16?
You should seek medico-legal advice if you have any uncertainty
What steps should be taken before termination of pregnancy?
- Confirm patient is pregnant
- Counsel her to help her reach the decision she will least regret
- Most clinics provide optional counselling - encourage to utilise this if she would find it helpful
- Discuss methods of abortion and choices available
- Ask her to consider alternatives
- Ask about her partner
- Ideally, allow her time to consider her decision
What is the main alternative to abortion?
Can the woman’s partner consent to, or refuse, TOP?
What should be considered when allowing a woman time to consider her decision to abort?
The earlier the termination is performed, the lower the risk of complications
What should be done if the patient decides on TOP?
- Screen for chlamydia
- Risk assessment for other STIs, and screen if indicated
- Discuss further contraceptive needs
- Check rhesus status
- Assess risk of VTE
- Establish if smear is due
What % of women attending abortion services screen positive for chlamydia?
What % of women with chlamydia would get post-operative salpingitis if untreated?
When can contraception be started after abortion?
Can start pill next day, or insert IUD at time