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TERMINATION OF PREGNANCY (FACTORS ASSOC WITH COPING PROBLEMS AND DISTRESS…
TERMINATION OF PREGNANCY
abortion can be performed if 2 doctors agree that the preg should be terminated on one or more grounds:
C- preg not exceeded its 24th week and continuance would involve risk > than if terminated, of injury to the phys or mental health of the preg woman
D- preg not exceeded its 24th week and continuance would involve risk > than if terminated, of injury to the phys or mental health of the existing children or the family of the preg woman
B- termination necessary to prevent grave permanent injury to the physical or mental health of the preg woman
E- there is a substantial risk if child were born it would suffer from such phys or mental abnorm as to be seriously handicap
A- continuance of preg would involve risk to the life of the preg woman > than if the pregnancy were terminated
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in emergency, can have a single signature
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PRE-ABORTION IX
prevention of infection - guidelines say all should be screened for chlamydia trachomatis and receive prophylactic abx [metronidazole + azithromycin] on day of abortion. can do contact tracing if pos for chlamyd
estimation of gestation - via clinical exam or US. US essential if chance of ectopic or where gest is unclear
BLOOD - Hb, sample sent for ABO and rhesus blood grouping. Women who are rhesus neg require anti-D ig after the abortion. HIV, haemoglobinopathy and other tests can be performed if indicated
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METHODS OF ABORTION
MEDICAL
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MID trimester
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mifepristone plus repeated doses of misoprostol (need to perform feticide intervention if over 22wks)
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SURGICAL
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below 7 weeks surg has higher failure than when done later. Do manual vacuum aspiration - important to ensure abortion complete, either by identifying the products of conception of by hCG follow up.
7-14wks
suction or vacuum - cervical prostaglandin before reduces risk of cervical trauma and uterine perforation = misoprostol vag or sublingually
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mifepristone (oral) is synthetic steroid - blocks progesterone action - after being administered can go home but return 24-48hrs later to administer prostaglandin (vaginally, bucally or sublingually)
bleeding usually starts within few hrs followed by uterine contractions which expel fetus and placenta
period pains exp, some need opiates
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