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 (D)</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 (D)</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% (B)</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 (A)</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 (A)</p> Signup and view all the answers

What is recommended for all women following TOP?

<p>Offering contraceptive information and method of choice (C)</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 (D)</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 (C)</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 (C)</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 (A)</p> Signup and view all the answers

What is emphasized as the preferred method of contraception?

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

'A comprehensive literature review' was conducted for:

<p>'National and international publications' (C)</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 (B)</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 (B)</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 (B)</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 (A)</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 (A)</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 (C)</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 (B)</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 (A)</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 (D)</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 (D)</p> Signup and view all the answers

Who reviewed all submissions made for the Guideline?

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

Which doctors drafted the Guideline?

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

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

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

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

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

Who approved the Guideline after it was drafted?

<p>Dr Sophie Boyd (A)</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 (B)</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 (B)</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 (D)</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 (C)</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 (A)</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 (A)</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 (A)</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 (C)</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 (D)</p> Signup and view all the answers

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

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

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

<p>1 in 1000 cases (A)</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 (A)</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 (B)</p> Signup and view all the answers

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

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

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

<p>Laparoscopy (D)</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 (D)</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 (A)</p> Signup and view all the answers

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

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

How does cervical laceration risk increase during STOP procedures?

<p>With advancing gestation (B)</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 (C)</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 (C)</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 (A)</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 (D)</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 (D)</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 (B)</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' (B)</p> Signup and view all the answers

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

<p>Retained pregnancy tissue (B)</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 (C)</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 (B)</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 (D)</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 (C)</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 (B)</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 (C)</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 (D)</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 (C)</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 (D)</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 (C)</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 (A)</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 (D)</p> Signup and view all the answers

What is NOT recommended regarding exposure to mifepristone?

<p>Administering misoprostol vaginally instead of buccally (C)</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 (D)</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 (B)</p> Signup and view all the answers

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

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

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

<p>Angiography (A)</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 (B)</p> Signup and view all the answers

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

<p>5-10% (A)</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 (B)</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 (D)</p> Signup and view all the answers

How can uterine perforation during surgical termination be managed?

<p>Prompt referral for laparoscopy (B)</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 (A)</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 (C)</p> Signup and view all the answers

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