Management Guidelines for Medication Exposure in Pregnancy
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Questions and Answers

What is NOT recommended regarding exposure to mifepristone?

  • Offering progesterone supplementation (correct)
  • Referral for pregnancy booking
  • Arranging an ultrasound for viability
  • Taking mifepristone alone without monitoring

    • What is the main concern associated with exposure to misoprostol?

  • Increased risk of fetal malformations (correct)
  • Risk of incomplete termination of pregnancy
  • Increased risk of maternal complications
  • Risk of ectopic pregnancy

    • Why should women who have been exposed to misoprostol undergo a detailed anomaly scan?

  • To detect any fetal anomalies (correct)
  • To identify potential ectopic pregnancies
  • To check the mother's health status
  • To assess the risk of maternal complications

    • What is a common cause of absent or scanty bleeding following MTOP in the community?

    <p>Ongoing pregnancy</p> Signup and view all the answers

    In MTOP, when does peak expulsion of pregnancy tissue typically occur following misoprostol administration?

    <p>4-6 hours later</p> Signup and view all the answers

    What is the approximate chance of an ongoing pregnancy after both mifepristone and misoprostol have been taken?

    <p>~3%</p> Signup and view all the answers

    Why should women receive further counseling regardless of the outcome of the pregnancy?

    <p>To address mental health concerns</p> Signup and view all the answers

    'Medical Termination of Pregnancy (MTOP) cannot be reversed' is included in counseling to emphasize what concept?

    <p>The finality of the procedure</p> Signup and view all the answers

    What is recommended for all women following TOP?

    <p>Offering contraceptive information and method of choice</p> Signup and view all the answers

    When should Long-acting reversible contraception (LARC) ideally be commenced after TOP?

    <p>At the time of TOP</p> Signup and view all the answers

    What is suggested for women admitted to the hospital with complications after TOP?

    <p>Referral to the Medical Social Work team and/or for counseling</p> Signup and view all the answers

    How should communication regarding complications of TOP to the GP TOP provider be made?

    <p>Via a discharge summary letter or directly by phone</p> Signup and view all the answers

    Where can the full guidelines on Investigation Assessment and Management of PMB be found?

    <p>At a specific URL provided in the text</p> Signup and view all the answers

    What is emphasized as the preferred method of contraception?

    <p>Long-acting reversible contraception (LARC)</p> Signup and view all the answers

    Who should be informed when a woman is admitted to the hospital with complications post-TOP?

    <p>The GP TOP provider</p> Signup and view all the answers

    'A comprehensive literature review' was conducted for:

    <p>'National and international publications'</p> Signup and view all the answers

    What is a suggestive sign of ongoing pregnancy after medical termination of pregnancy (MTOP)?

    <p>Persistence of pregnancy symptoms for more than five to seven days after MTOP</p> Signup and view all the answers

    What follow-up appointment should be offered to women after medical termination of pregnancy in the community?

    <p>In-person follow-up two weeks after taking medication</p> Signup and view all the answers

    Why is ensuring medical termination completion more critical for women in Ireland?

    <p>Due to the legal gestational limit of 12 weeks or a CRL of ≤63mm</p> Signup and view all the answers

    When should women be advised to perform a LSUPT test post administration of mifepristone?

    <p>14 days post administration of mifepristone</p> Signup and view all the answers

    What timeframe is considered close to the gestational community limit for MTOP in the text?

    <p>Around 69 days from LMP</p> Signup and view all the answers

    Which action should be taken if a woman fails to pass expected pregnancy tissue after MTOP?

    <p>Contact provider for advice and possible referral to secondary care</p> Signup and view all the answers

    Why should vomiting within an hour of administration of mifepristone be avoided?

    <p>It may reduce the medication's effectiveness</p> Signup and view all the answers

    What is suggested if women undergo MTOP close to the gestational community limit?

    <p>Consideration of enhanced follow-up protocol</p> Signup and view all the answers

    Who performed the literature search for clinical questions applicable to the primary care setting?

    <p>Dr Sinead Feeney</p> Signup and view all the answers

    Which doctors performed a literature review for questions applicable to the secondary care setting?

    <p>Dr Sophie Boyd and Dr Deidre Hayes Ryan</p> Signup and view all the answers

    Who reviewed all submissions made for the Guideline?

    <p>Dr Sophie Boyd</p> Signup and view all the answers

    Which doctors drafted the Guideline?

    <p>Dr Sophie Boyd and Dr Deidre Hayes Ryan</p> Signup and view all the answers

    What process does GRADE offer for developing and presenting evidence summaries?

    <p>Transparent and structured process</p> Signup and view all the answers

    When was the literature review process conducted by the Guideline writing group?

    <p>December 2021 - February 2022</p> Signup and view all the answers

    Who approved the Guideline after it was drafted?

    <p>Dr Sophie Boyd</p> Signup and view all the answers

    What is the focus of the study in the article 'Pain of first-trimester abortion: a study of psychosocial and medical predictors'?

    <p>Psychosocial predictors of abortion</p> Signup and view all the answers

    Which medical journal published the research on oxytocin receptors in the human uterus during pregnancy and parturition?

    <p>American Journal of Obstetrics and Gynecology</p> Signup and view all the answers

    What is the main focus of the RCOG guideline number 7?

    <p>Care of women requesting induced abortion</p> Signup and view all the answers

    In the study by Carlsson et al., what type of study design was used?

    <p>Retrospective and longitudinal follow-up study</p> Signup and view all the answers

    What is the focus of the article 'Three-Dimensional Doppler Sonography in Asymptomatic and Symptomatic Women After Medical Termination of Pregnancy'?

    <p>Use of sonography after medical termination of pregnancy</p> Signup and view all the answers

    Which medical journal published the research on 'Management of the third stage of labor in pregnancies terminated by prostaglandin E2'?

    <p>American Journal of Obstetrics and Gynecology</p> Signup and view all the answers

    What is the topic of the Cochrane Database Systematic Review by May et al.?

    <p>Antibiotics for incomplete abortion</p> Signup and view all the answers

    'Induced Abortion: Surgical Abortion and Second Trimester Medical Methods' is most likely published in which type of publication?

    <p>Medical journal</p> Signup and view all the answers

    'National Clinical Practice Guideline Investigation and Management of Complications of Early Termination of Pregnancy' is most likely focused on what aspect?

    <p>'Investigation and management' of complications post-abortion</p> Signup and view all the answers

    'RCOG – Making Abortion Safe' is likely to provide guidance on:

    <p>'Best practices' for safe abortions</p> Signup and view all the answers

    What is the approximate risk of uterine perforation with surgical termination?

    <p>1 in 1000 cases</p> Signup and view all the answers

    Which of the following factors does NOT increase the risk of uterine perforation during surgical termination?

    <p>Use of experienced providers</p> Signup and view all the answers

    When does uterine perforation most commonly occur during first-trimester surgical termination?

    <p>At the time of cervical dilation</p> Signup and view all the answers

    What is the recommended management approach if uterine perforation is detected during STOP?

    <p>Laparoscopy or laparotomy</p> Signup and view all the answers

    Which procedure may be required if interventional radiology is not available for managing uterine perforation?

    <p>Laparoscopy</p> Signup and view all the answers

    What resuscitative measures are recommended if severe genital tract infection is suspected following examination?

    <p>Starting intravenous fluids and broad-spectrum antibiotics</p> Signup and view all the answers

    Why should inhalation agents such as nitrous oxides or isoflurane be avoided during surgical terminations under general anaesthetic?

    <p>They increase the risk of complications and blood loss</p> Signup and view all the answers

    Which antibiotic type is NOT recommended for prophylaxis in surgical terminations?

    <p>Aminoglycosides (gentamicin)</p> Signup and view all the answers

    What is the preferred method for emptying the uterus during vacuum aspiration?

    <p>Using a suction cannula and forceps if required</p> Signup and view all the answers

    What is the recommended anesthesia technique for surgical terminations?

    <p>Total intravenous anesthesia (TIVA) with IV propofol and fentanyl</p> Signup and view all the answers

    How is cervical priming recommended prior to all surgical terminations?

    <p>Through the use of osmotic dilators in second-trimester terminations</p> Signup and view all the answers

    What is the indicated management approach for persistent bleeding from a tenaculum site during an STOP?

    <p>Direct compression with a sponge stick</p> Signup and view all the answers

    How does cervical laceration risk increase during STOP procedures?

    <p>With advancing gestation</p> Signup and view all the answers

    What is the recommended action for haematometra in the context of uterine perforation?

    <p>Immediate re-aspiration and drainage</p> Signup and view all the answers

    What can be done to manage a small and superficial laceration during an STOP procedure?

    <p>Direct compression with a ring forceps</p> Signup and view all the answers

    What should be considered if a woman's status or findings during laparoscopy suggest damage to the bowel, blood vessels, or other structures?

    <p>Perform a laparotomy for repair if needed</p> Signup and view all the answers

    In the context of uterine perforation management, which specialist may need to be involved to ensure appropriate management of complications?

    <p>Colorectal, vascular, or urological surgeons</p> Signup and view all the answers

    What investigation method is recommended when laparoscopy is needed to assess possible damage during uterine perforation management?

    <p>Laparoscopy</p> Signup and view all the answers

    If laparoscopy reveals damage to the bowel during uterine perforation management, what may be required to repair the damage?

    <p>Laparotomy</p> Signup and view all the answers

    What should healthcare workers providing STOP be familiar with regarding potential complications like haemorrhage and uterine perforation?

    <p>'Potential complications such as haemorrhage, cervical lacerations and uterine perforation and their respective management approaches'</p> Signup and view all the answers

    What is a potential cause of haemorrhage at the time of surgical termination?

    <p>Retained pregnancy tissue</p> Signup and view all the answers

    Which treatment option is NOT appropriate for haemorrhage at the time of surgical termination?

    <p>Intrauterine tamponade with bimanual compression</p> Signup and view all the answers

    What is a potential complication of sharp curettage during a surgical termination procedure?

    <p>Increased risk of perforation</p> Signup and view all the answers

    What is the recommended approach for managing haemorrhage in a woman undergoing surgical termination?

    <p>Treatment based on the cause and severity</p> Signup and view all the answers

    When should re-evacuation of the uterus be considered for managing haemorrhage during surgical termination?

    <p>In all cases of haemorrhage</p> Signup and view all the answers

    What is the recommended management approach for a haemodynamically unstable woman with heavy vaginal bleeding secondary to retained pregnancy tissue?

    <p>Resuscitative measures and prompt uterine evacuation</p> Signup and view all the answers

    In case of suspected severe genital tract infection post examination, what is the appropriate immediate action recommended?

    <p>Commence intravenous fluids and broad-spectrum antibiotics</p> Signup and view all the answers

    What is suggested if a woman in the community experiences heavy vaginal bleeding that persists and is not haemodynamically unstable?

    <p>Manage conservatively in the community</p> Signup and view all the answers

    What should be advised if a woman has prolonged, ongoing bleeding following early termination of pregnancy?

    <p>Secondary care referral for conservative management</p> Signup and view all the answers

    When might preliminary investigations and oral broad-spectrum antibiotics be considered appropriate in managing mild genital tract infection?

    <p>For symptomatic women without haemodynamic instability</p> Signup and view all the answers

    What is the recommended management approach if uterine perforation is detected during STOP?

    <p>Immediate referral to secondary care for surgical management</p> Signup and view all the answers

    What procedure may be required if interventional radiology is not available for managing uterine perforation?

    <p>Urgent laparotomy for exploratory surgery</p> Signup and view all the answers

    When does uterine perforation most commonly occur during first-trimester surgical termination?

    <p>During the dilation and curettage (D&amp;C) procedure</p> Signup and view all the answers

    What is NOT recommended regarding exposure to mifepristone?

    <p>Administering misoprostol vaginally instead of buccally</p> Signup and view all the answers

    Why should women receive further counseling regardless of the outcome of the pregnancy?

    <p>To address any emotional or psychological implications</p> Signup and view all the answers

    What is recommended if a woman fails to pass expected pregnancy tissue after medical termination of pregnancy?

    <p>Proceed to a second round of medical management</p> Signup and view all the answers

    When is uterine perforation most likely to occur during first-trimester surgical termination?

    <p>During uterine sounding</p> Signup and view all the answers

    If interventional radiology is not available to manage uterine perforation, what procedure may be required?

    <p>Angiography</p> Signup and view all the answers

    What should be done if severe genital tract infection is suspected following examination?

    <p>Administer broad-spectrum antibiotics</p> Signup and view all the answers

    What is the approximate risk of uterine perforation with surgical termination?

    <p>5-10%</p> Signup and view all the answers

    When should further counseling be provided to women undergoing termination of pregnancy?

    <p>Regardless of the outcome of the pregnancy</p> Signup and view all the answers

    Which action should be taken if a woman does not pass appropriate pregnancy tissue after medical termination of pregnancy (MTOP)?

    <p>Proceed to a second round of medical management</p> Signup and view all the answers

    How can uterine perforation during surgical termination be managed?

    <p>Prompt referral for laparoscopy</p> Signup and view all the answers

    When should Long-acting reversible contraception (LARC) ideally be commenced after termination of pregnancy?

    <p>After confirmation of complete expulsion</p> Signup and view all the answers

    What should be done if uterine perforation is detected during surgical termination?

    <p>Treat conservatively unless severe bleeding occurs</p> Signup and view all the answers

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