Enhanced Reproductive Care & Termination Provision
Explore the evolution of reproductive care within general practice and maternity hospitals, with a focus on termination of pregnancy. Learn about the progress, key considerations, and processes involved in providing enhanced reproductive services.
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Presentation Transcript
POSITION PAPER on Provision of Termination of Pregnancy & enhanced Reproductive Care within the existing General Practice & Maternity Hospital setting.
And you may ask yourself, well How did I get here?
PROGRESS TO DATE April 2018- Doctors TFY Repeal the 8thWhatsApp / Meeting in UCC 25thMay 2018- Repeal of 8thAmendment START Thurs 31stMay meeting post Referdum and name change Regular meetings throughout summer. Thursday 19thJuly- Educational meeting What do we do with all this information Mid August proposal for Position Paper 10 Authors, 2 editors, 12 drafts
WHAT WE NOW KNOW General Practice is suitable for most Early Medical Abortions (EMA, LMP < 63 days). Over 63 days will need to be in secondary care. A 24/7 telephone helpline staffed by trained personnel will be an essential service to co-ordinate care, arrange appointment with providers, avoid obstructers, give reassurance or referral during TOP Most pregnant people who attend for TOP are sure of their decision. Most pregnant people who attend for TOP are sure of their dates. Ultrasound is not generally needed pre 63 days Anti-D is not needed pre 63 days
First visit Involved not complicated Discuss decision making process Decision made without coercion, informed consent Confirmation of dates, abdominal NOT bimanual exam Invx Haemoglobin essential, others (serum HCG, Blood group+ antibodies) STI screening Prescribing and dispensing medication Safety net Contraceptive plan
Termination of Pregnancy <12 weeks 24 hour helpline: access, medical queries, referral to counselling / information < 9 weeks Meets with GP > 9 weeks Meets with GP Refers Self to Hospital Sure of hx/dates No Concerns [IAPC, Psych, Refuge, DV, SATU] GP Certification Mifepristone Misoprostol (HOME) Unsure re hx/dates Other risk factors Refers to Hospital +/- Other services Scan clinic (H) - dates Information re options Medical Review Refers to Hospital Scan clinic Hospital Certification Planning of admission Mifepristone Dates confirmed Dates > 9 weeks Misoprostol (IN PATIENT) Anti-D GP Follow up visit HCG test All well immediate contraception Incomplete Scan clinic (H) Medical review Complete Concerns [incomplete, failed, EP, Bleeding] Repeat Meds ERPC/ STOP Refers to Hospital Hospital Discharge (+) GP Follow up visit Offer of counselling (+/-) Contraception
NONE OF THIS CAN BE DONE WITHOUT SECONDARY CARE
