86 Questions
What is NOT recommended regarding exposure to mifepristone?
Offering progesterone supplementation
What is the main concern associated with exposure to misoprostol?
Increased risk of fetal malformations
Why should women who have been exposed to misoprostol undergo a detailed anomaly scan?
To detect any fetal anomalies
What is a common cause of absent or scanty bleeding following MTOP in the community?
Ongoing pregnancy
In MTOP, when does peak expulsion of pregnancy tissue typically occur following misoprostol administration?
4-6 hours later
What is the approximate chance of an ongoing pregnancy after both mifepristone and misoprostol have been taken?
~3%
Why should women receive further counseling regardless of the outcome of the pregnancy?
To address mental health concerns
'Medical Termination of Pregnancy (MTOP) cannot be reversed' is included in counseling to emphasize what concept?
The finality of the procedure
What is recommended for all women following TOP?
Offering contraceptive information and method of choice
When should Long-acting reversible contraception (LARC) ideally be commenced after TOP?
At the time of TOP
What is suggested for women admitted to the hospital with complications after TOP?
Referral to the Medical Social Work team and/or for counseling
How should communication regarding complications of TOP to the GP TOP provider be made?
Via a discharge summary letter or directly by phone
Where can the full guidelines on Investigation Assessment and Management of PMB be found?
At a specific URL provided in the text
What is emphasized as the preferred method of contraception?
Long-acting reversible contraception (LARC)
Who should be informed when a woman is admitted to the hospital with complications post-TOP?
The GP TOP provider
'A comprehensive literature review' was conducted for:
'National and international publications'
What is a suggestive sign of ongoing pregnancy after medical termination of pregnancy (MTOP)?
Persistence of pregnancy symptoms for more than five to seven days after MTOP
What follow-up appointment should be offered to women after medical termination of pregnancy in the community?
In-person follow-up two weeks after taking medication
Why is ensuring medical termination completion more critical for women in Ireland?
Due to the legal gestational limit of 12 weeks or a CRL of ≤63mm
When should women be advised to perform a LSUPT test post administration of mifepristone?
14 days post administration of mifepristone
What timeframe is considered close to the gestational community limit for MTOP in the text?
Around 69 days from LMP
Which action should be taken if a woman fails to pass expected pregnancy tissue after MTOP?
Contact provider for advice and possible referral to secondary care
Why should vomiting within an hour of administration of mifepristone be avoided?
It may reduce the medication's effectiveness
What is suggested if women undergo MTOP close to the gestational community limit?
Consideration of enhanced follow-up protocol
Who performed the literature search for clinical questions applicable to the primary care setting?
Dr Sinead Feeney
Which doctors performed a literature review for questions applicable to the secondary care setting?
Dr Sophie Boyd and Dr Deidre Hayes Ryan
Who reviewed all submissions made for the Guideline?
Dr Sophie Boyd
Which doctors drafted the Guideline?
Dr Sophie Boyd and Dr Deidre Hayes Ryan
What process does GRADE offer for developing and presenting evidence summaries?
Transparent and structured process
When was the literature review process conducted by the Guideline writing group?
December 2021 - February 2022
Who approved the Guideline after it was drafted?
Dr Sophie Boyd
What is the focus of the study in the article 'Pain of first-trimester abortion: a study of psychosocial and medical predictors'?
Psychosocial predictors of abortion
Which medical journal published the research on oxytocin receptors in the human uterus during pregnancy and parturition?
American Journal of Obstetrics and Gynecology
What is the main focus of the RCOG guideline number 7?
Care of women requesting induced abortion
In the study by Carlsson et al., what type of study design was used?
Retrospective and longitudinal follow-up study
What is the focus of the article 'Three-Dimensional Doppler Sonography in Asymptomatic and Symptomatic Women After Medical Termination of Pregnancy'?
Use of sonography after medical termination of pregnancy
Which medical journal published the research on 'Management of the third stage of labor in pregnancies terminated by prostaglandin E2'?
American Journal of Obstetrics and Gynecology
What is the topic of the Cochrane Database Systematic Review by May et al.?
Antibiotics for incomplete abortion
'Induced Abortion: Surgical Abortion and Second Trimester Medical Methods' is most likely published in which type of publication?
Medical journal
'National Clinical Practice Guideline Investigation and Management of Complications of Early Termination of Pregnancy' is most likely focused on what aspect?
'Investigation and management' of complications post-abortion
'RCOG – Making Abortion Safe' is likely to provide guidance on:
'Best practices' for safe abortions
What is the approximate risk of uterine perforation with surgical termination?
1 in 1000 cases
Which of the following factors does NOT increase the risk of uterine perforation during surgical termination?
Use of experienced providers
When does uterine perforation most commonly occur during first-trimester surgical termination?
At the time of cervical dilation
What is the recommended management approach if uterine perforation is detected during STOP?
Laparoscopy or laparotomy
Which procedure may be required if interventional radiology is not available for managing uterine perforation?
Laparoscopy
What resuscitative measures are recommended if severe genital tract infection is suspected following examination?
Starting intravenous fluids and broad-spectrum antibiotics
Why should inhalation agents such as nitrous oxides or isoflurane be avoided during surgical terminations under general anaesthetic?
They increase the risk of complications and blood loss
Which antibiotic type is NOT recommended for prophylaxis in surgical terminations?
Aminoglycosides (gentamicin)
What is the preferred method for emptying the uterus during vacuum aspiration?
Using a suction cannula and forceps if required
What is the recommended anesthesia technique for surgical terminations?
Total intravenous anesthesia (TIVA) with IV propofol and fentanyl
How is cervical priming recommended prior to all surgical terminations?
Through the use of osmotic dilators in second-trimester terminations
What is the indicated management approach for persistent bleeding from a tenaculum site during an STOP?
Direct compression with a sponge stick
How does cervical laceration risk increase during STOP procedures?
With advancing gestation
What is the recommended action for haematometra in the context of uterine perforation?
Immediate re-aspiration and drainage
What can be done to manage a small and superficial laceration during an STOP procedure?
Direct compression with a ring forceps
What should be considered if a woman's status or findings during laparoscopy suggest damage to the bowel, blood vessels, or other structures?
Perform a laparotomy for repair if needed
In the context of uterine perforation management, which specialist may need to be involved to ensure appropriate management of complications?
Colorectal, vascular, or urological surgeons
What investigation method is recommended when laparoscopy is needed to assess possible damage during uterine perforation management?
Laparoscopy
If laparoscopy reveals damage to the bowel during uterine perforation management, what may be required to repair the damage?
Laparotomy
What should healthcare workers providing STOP be familiar with regarding potential complications like haemorrhage and uterine perforation?
'Potential complications such as haemorrhage, cervical lacerations and uterine perforation and their respective management approaches'
What is a potential cause of haemorrhage at the time of surgical termination?
Retained pregnancy tissue
Which treatment option is NOT appropriate for haemorrhage at the time of surgical termination?
Intrauterine tamponade with bimanual compression
What is a potential complication of sharp curettage during a surgical termination procedure?
Increased risk of perforation
What is the recommended approach for managing haemorrhage in a woman undergoing surgical termination?
Treatment based on the cause and severity
When should re-evacuation of the uterus be considered for managing haemorrhage during surgical termination?
In all cases of haemorrhage
What is the recommended management approach for a haemodynamically unstable woman with heavy vaginal bleeding secondary to retained pregnancy tissue?
Resuscitative measures and prompt uterine evacuation
In case of suspected severe genital tract infection post examination, what is the appropriate immediate action recommended?
Commence intravenous fluids and broad-spectrum antibiotics
What is suggested if a woman in the community experiences heavy vaginal bleeding that persists and is not haemodynamically unstable?
Manage conservatively in the community
What should be advised if a woman has prolonged, ongoing bleeding following early termination of pregnancy?
Secondary care referral for conservative management
When might preliminary investigations and oral broad-spectrum antibiotics be considered appropriate in managing mild genital tract infection?
For symptomatic women without haemodynamic instability
What is the recommended management approach if uterine perforation is detected during STOP?
Immediate referral to secondary care for surgical management
What procedure may be required if interventional radiology is not available for managing uterine perforation?
Urgent laparotomy for exploratory surgery
When does uterine perforation most commonly occur during first-trimester surgical termination?
During the dilation and curettage (D&C) procedure
What is NOT recommended regarding exposure to mifepristone?
Administering misoprostol vaginally instead of buccally
Why should women receive further counseling regardless of the outcome of the pregnancy?
To address any emotional or psychological implications
What is recommended if a woman fails to pass expected pregnancy tissue after medical termination of pregnancy?
Proceed to a second round of medical management
When is uterine perforation most likely to occur during first-trimester surgical termination?
During uterine sounding
If interventional radiology is not available to manage uterine perforation, what procedure may be required?
Angiography
What should be done if severe genital tract infection is suspected following examination?
Administer broad-spectrum antibiotics
What is the approximate risk of uterine perforation with surgical termination?
5-10%
When should further counseling be provided to women undergoing termination of pregnancy?
Regardless of the outcome of the pregnancy
Which action should be taken if a woman does not pass appropriate pregnancy tissue after medical termination of pregnancy (MTOP)?
Proceed to a second round of medical management
How can uterine perforation during surgical termination be managed?
Prompt referral for laparoscopy
When should Long-acting reversible contraception (LARC) ideally be commenced after termination of pregnancy?
After confirmation of complete expulsion
What should be done if uterine perforation is detected during surgical termination?
Treat conservatively unless severe bleeding occurs
Learn important guidelines for managing medication exposure during pregnancy, including when to arrange an ultrasound for viability and avoid offering progesterone supplementation. Understand the risks associated with exposure to mifepristone and misoprostol.
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