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3bde326f405a2de2 | ### Rationale
This has been further developed in ['Safer Maternity Care: The National Maternity Safety](https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/662969/Safer_maternity_care_-_progress_and_next_steps.pdf) Strategy – [Progress and Next Steps'](https://assets.publish... |
90c51b17c1738fc1 | ### Rationale
educed' and set an additional ambition to reduce the national rate of preterm births from 8% to 6%. The current scope of NICE preterm guidelines is limited to principally to acute presentation , and this document specifies those at-risk populations who should be targeted for additional referral and manag... |
873a92fd1d889f99 | ### Implementation
All the elements within SBLCBv2 address iatrogenic preterm and early term birth, recognising the need to ensure that any decision for delivery is based on evidence of maternal and/or fetal compromise. This element focuses on reducing spontaneous preterm birth via prediction, prevention, and optimisa... |
3cf22cd821466971 | ### Implementation
- Providers should identify a clinical lead for preterm birth prevention to oversee development of clinical guidelines and pathways of care, responsibility for quality, governance and training, involvement in research studies and registries and involvement regionally within the local preterm birth n... |
9a30cf5b321552ed | ### Implementation
fibronectin and potential interventions, for example, cervical cerclage, pessary and progesterone. Where preterm birth prevention clinics are not available providers must ensure that women are able to access care that guarantees that they are given evidence-based information, access to risk assessme... |
eb9154f595be9e58 | ### Implementation
Trusts are encouraged to implement these changes using strategies recommended by the [Maternal and Neonatal Health Safety Collaborative.](https://improvement.nhs.uk/resources/maternal-and-neonatal-safety-collaborative/)
Further guidance regarding the care of women and their babies at risk of preter... |
39d8c88936225f75 | ### Implementation
- [NICE Guideline NG25 'Preterm labour and birth'](https://www.nice.org.uk/guidance/ng25)
- [NICE Diagnostics Guidance DG33 'Biomarker tests to help diagnose preterm labour in](http://www.nice.org.uk/guidance/dg33) [women with intact membranes'](http://www.nice.org.uk/guidance/dg33)
- UK Preterm Cli... |
4dce938d067f2f01 | ## Appendix B: Detailed 'safe and healthy pregnancy' messages
There are numerous causes of stillbirth, many of which are poorly understood. Surveillance work by *[MBRRACE-UK](https://www.npeu.ox.ac.uk/mbrrace-uk)* highlights that BAME women, older women, teenagers and those living in poverty are at increased risk62. H... |
a4747eaa9e76fa7f | ### Background
Women with no experience of stillbirth or perinatal death don't want to be made to feel unnecessarily anxious, but do want to know what they can do to help themselves and their baby stay safer in pregnancy.
Women whose baby has died may feel guilt and that their behaviour was to blame for what happened... |
be6517602e4128ab | ### Safe and healthy pregnancy messages
The section below contains additional information which may support conversations with women around these 'safe and healthy pregnancy' messages.
**Advice point:** Choose when to start or grow your family by using contraception. **Why is this important?** Worse outcomes are link... |
04cc5537becdd032 | ### Safe and healthy pregnancy messages
**Why is this important?** Women who are overweight or obese before they conceive have an increased risk of complications during pregnancy and birth. They also face an increased risk that their baby will be stillborn.
**Tips:** Encourage women who are overweight or obese to:
-... |
f4c3c07a07497115 | ### Safe and healthy pregnancy messages
While pregnancy isn't the time for a weight-loss diet, it is a good time to adopt a healthy diet, so encourage women to swap unhealthy foods for healthier options and try to keep active. Reassure women that, even during the last few months of pregnancy, they only need an extra 2... |
201582ba9e2a5f0c | ### Safe and healthy pregnancy messages
**Advice point:** Take a daily supplement of 400 micrograms (400 µg) folic acid before conception and until the 12th week of pregnancy (some women will require a higher dose as advised by a healthcare professional). Pregnant women (and all adults, including breastfeeding women) ... |
06d7ebbc6a39542e | ### Safe and healthy pregnancy messages
**Why is this important?** Folic acid (also known as vitamin B9) is very important for the development of a healthy fetus, as it can significantly reduce the risk of neural tube defects (NTDs), such as spina bifida. A high proportion of women are still unaware of the recommendat... |
0fd33f1c8817c35b | ### Safe and healthy pregnancy messages
**Why is this important?** Some disorders can be passed from parents to their children through their genes, and these can be more common in some groups of people.
**Tip:** Encourage women to speak to their GP to see if they and/or their partners should be screened before becomi... |
8f1ae0805dc01569 | ### Safe and healthy pregnancy messages
- Baby's movements have reduced, slowed down or changed
- Bleeding from the vagina
- Watery, clear or coloured discharge from the vagina which seems abnormal
- Signs of pre-eclampsia, such as obvious swelling, especially affecting the hands and face or upper body; severe headach... |
f1dd66760b3a6b5d | ### Safe and healthy pregnancy messages
**Tip:** Also talk about how itching, particularly on the hands and feet, can be a sign of the liver disorder called intrahepatic cholestasis of pregnancy; women should get in touch within 24 hours if they experience itching.
**Advice point:** Stop smoking. Smoking affects the ... |
3023f1fa18ecb411 | ### Safe and healthy pregnancy messages
**Tips:** A woman may be worried about sharing this information – reassure her that it will be treated in strict confidence and will only be shared with relevant health professionals if that's in the best interest of the baby.
Women can contact [FRANK](http://www.talktofrank.co... |
57297e36924666a5 | ### Safe and healthy pregnancy messages
**Why is this important?** Pregnant women have a much higher risk of serious illness as a result of flu compared with the general population. In addition, influenza during pregnancy may also be associated with perinatal mortality, prematurity, smaller neonatal size and lower bir... |
ce5aa24ae43ac05f | ### Safe and healthy pregnancy messages
developed countries for many years, with no reported safety issues relating to inactivated flu vaccination.
**Action point:** Have the pertussis (whooping cough) vaccination. It's safe, effective and free of charge to pregnant women.
**Why is this important?** Pertussis can le... |
96b4cb0b52d3052b | ### Safe and healthy pregnancy messages
**Tips:** You can be reassuring that vaccine containing pertussis can be safely given to pregnant women from 16 weeks gestation. It is 97% effective in preventing death from pertussis in babies less than 3 months. The mother's antibodies that are generated in response to the vac... |
f8e0c8e2bf8bef4b | ### Safe and healthy pregnancy messages
**Why is this important?** The immune system becomes weaker in pregnancy, so pregnant women are more at risk of infections. Some can increase the risk of stillbirth and/or maternal and perinatal complications.
**Tips:** Encourage women to:
- be strict about good hygiene washin... |
861eb626eb575f0c | ### Safe and healthy pregnancy messages
**Action point:** Remember the importance of handwashing to reduce the risk of CMV (cytomegalovirus) infection
**Why is this important?** CMV is a common virus, similar to the herpes virus that causes cold sores and chickenpox. Infection can be dangerous during pregnancy as it ... |
351f2e871c524abd | ### Safe and healthy pregnancy messages
**Why is this important?** For pregnant women, the blood flow going to the baby may be reduced or interrupted if they spend a long time lying on their back. Research has linked this with an increased risk of stillbirth.
**Tips:** Encourage women to settle on their side when the... |
28248b5e6a21ff9a | ## Appendix C: Medication to reduce the risk of pregnancy complications
All women should take a daily supplement of 400 micrograms (400 µg) folic acid before conception and until the 12th week of pregnancy (some women will require a higher dose as advised by a healthcare professional). Pregnant women (and all adults, ... |
932b8e352bc9f2c6 | #### **Dosage**
There is evidence from randomised controlled trials that the dose of aspirin should be 150mg from 12 weeks' gestation, and may be more effective if taken at night65. In some circumstances this may not be appropriate and lower doses (60-75mg) may be used (for example, women with hepatic or renal disease... |
966c5fee157d8013 | #### **Dosage**
Although this use is common in UK clinical practice, at the time of publication (June 2019), aspirin did not have a UK marketing authorisation for this indication. Community pharmacies cannot legally sell aspirin as a Pharmacy Only Medicine for prevention of pre-eclampsia in pregnancy in England. Aspi... |
2abc18fa3bdfae13 | #### **Dosage**
**Table 1**: Clinical risk assessment for preeclampsia as indications for aspirin in pregnancy |
87530b1ca73a2aa8 | #### **Dosage**
| Risk level | Risk factors | Recommendation | | | |
|------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------... |
74ffeca5a182d0a7 | #### **Dosage**
| Risk level | Risk factors | Recommendation | | | |
|------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------... |
4ee21ea3e97ba738 | #### **Dosage**
There are a few absolute contraindications to aspirin therapy67. Women with a history of aspirin allergy (for example, urticaria) or hypersensitivity to other salicylates are at risk of anaphylaxis and should not receive aspirin. There is significant cross-sensitivity between aspirin and other nonstero... |
5f56a03fe653abf8 | #### **Definition of FGR in a current pregnancy:** defined as either of the following:
- EFW or abdominal circumference (AC) 95th centile70) earlier in pregnancy (20 – 24 weeks) and/or
- o Abnormal umbilical artery Doppler (absent or reversed end diastolic flow or pulsatility index >95th centile). |
0580244d1746e920 | #### **Suboptimal fetal growth:**
• Increase in EFW <280g over 14 days (20g per day) from 34 weeks . |
b287133916a954dd | #### **Risk assessment and the role of uterine artery Doppler measurement**
Early onset FGR is rare (~0.5%73). The vast majority of cases are associated with abnormal uterine artery Doppler indices or already present estimated fetal weight (EFW) <10th centile in the early third trimester. Thus, uterine artery Doppler ... |
3c8c587225085a2c | #### **Risk assessment and the role of uterine artery Doppler measurement**
Where women have accepted the offer of a screening scan for fetal anomalies the uterine artery doppler can be measured at the anomaly scan. This is an additional clinical requirement and does not form part of the [FASP anatomical base menu.](h... |
eb0ed7d5b96123be | #### **Risk assessment and the role of uterine artery Doppler measurement**
It is important that the primary indication for this appointment is the 18+0 to 20+6 week screening scan. |
71ade9a83d547786 | #### **Risk assessment and the role of uterine artery Doppler measurement**
Trusts may decide to invest in training ultrasonographers to perform uterine artery Doppler alongside the fetal anomaly scan with the opportunity to reduce the number of serial scans for growth that a woman would require during the pregnancy. ... |
3d3475fba0f71260 | #### **Risk assessment and the role of uterine artery Doppler measurement**
Ongoing surveillance for fetal growth should be performed at intervals of at least 14 days, with optimum assessment for growth velocity being 21 – 28 days. For the vast majority of pregnancies in the moderate risk category or in those unsuitab... |
379b56341342aab4 | #### **Risk assessment and the role of uterine artery Doppler measurement**
It should be noted that there are reference ranges available for uterine artery Doppler PI throughout pregnancy and thus while offering at the time of the fetal anomaly scan is appropriate (for resource use and convenience), the measurement ma... |
645ceb7b4ba35923 | #### **Risk assessment and the role of uterine artery Doppler measurement**
| | Risk assessment t booking and mid-trimester anomaly scan) | Prevention | Risk assessment for early onset FGR and triage to pathway Detection/surveillance pathway for FGR/SGA |
747c8296cda66274 | #### **Risk assessment and the role of uterine artery Doppler measurement**
--------------------------------------------------------------------------------------------------|
| Low risk | No risk factors | Nil | Anomaly scan and EFW ≥10 centile Serial measurement of SFH |
ef80eb8f2dc352e1 | #### **Risk assessment and the role of uterine artery Doppler measurement**
--------------------------------------------------------------------------------------------------|
| Moderate risk | Moderate risk factors Obstetric history Previous SGA Previous stillbirth, AGA birthweight Current risk factor Current smoker ... |
890b5ce2305b7c7b | #### **Risk assessment and the role of uterine artery Doppler measurement**
| Assess for complications developing in pregnancy, e.g. hypertensive disorders or significant bleeding | |
cf1673d9d66428d5 | #### **Risk assessment and the role of uterine artery Doppler measurement**
--------------------------------------------------------------------------------------------------|
| High risk | High risk factors Medical history Maternal medical conditions [chronic kidney disease, hypertension, autoimmune disease (SLE, APL... |
d1527d1ece0fd718 | #### **Risk assessment and the role of uterine artery Doppler measurement**
Discussion with fetal medicine Discussion with fetal medicine Discussion with fetal medicine Discussion with fetal medicine Discussion with fetal medicine Discussion with fetal medicine Discussion with fetal medicine Discussion with fetal medi... |
9cbc265327a5fd4e | #### **Risk assessment and the role of uterine artery Doppler measurement**
--------------------------------------------------------------------------------------------------|
| Other | Women unsuitable for monitoring of growth by SFH measurement (e.g. |
0cc2cfe0e73fabd2 | #### **Risk assessment and the role of uterine artery Doppler measurement**
| | |
79790cacc772fd28 | #### **Risk assessment and the role of uterine artery Doppler measurement**
The risk factors listed here constitute those routinely assessed at booking, other risk factors exist and risk assessment must always be individualised taking into account previous medical and obstetric history and current pregnancy history. F... |
9e66a96feaeacb4d | #### **Risk assessment and the role of uterine artery Doppler measurement**
†AC and/or EFW <10 centile at the anomaly scan is a high risk factor. \* Refer to risk assessment and identification section for advice on scan interval. |
04cd2c969c3b775d | #### **Management of FGR**
The RCOG provides detailed recommendations for the monitoring of SGA when EFW is <10th centile and Trusts should either follow this guidance or a similar protocol which has been agreed with local commissioners (CCGs) following advice from the provider's Clinical Network as to whether the var... |
b72ba0bed469f49c | #### **Management of FGR**
- Absent or reversed end diastolic flow in the umbilical artery is a feature of FGR prior to 32 weeks.
- Ductus venosus (DV) Doppler is less predictive after 32 weeks in the management of the FGR fetus.
- A normal umbilical artery Doppler after 32 weeks of gestation does not mean that the fe... |
b8b5a4f48af42193 | #### **Management of FGR**
Thus, prior to 34 weeks, management of the FGR fetus will require network specialist fetal medicine input to determine the most appropriate monitoring for fetal wellbeing and timing of delivery where fetal compromise is demonstrated.
Trusts caring for such women should have access to person... |
7bff7f6fc8d46a35 | #### **Management of FGR**
For fetuses with an EFW <3rd centile in later pregnancy delivery should be initiated at 37+0 weeks' gestation (or earlier if there are other concerning features present depending on the protocol).
In fetuses with an EFW between the 3rd and 10th centile, other features must be present for de... |
f685e561a247e68d | #### **Management of FGR**
For all fetuses with an EFW or AC <10th centile where FGR has been excluded, delivery or the initiation of induction of labour should be offered at 39+0 weeks after discussion with the mother.
For women who decline induction of labour or delivery after 39+0 weeks, counselling must include a... |
9572049031e02fda | ## Appendix E: Risk assessment at the onset of labour
This guidance is based on NICE [intrapartum care for healthy women and babies](https://www.nice.org.uk/guidance/cg190/chapter/Recommendations#initial-assessment) guidance. Any variations of this pathway should be agreed with local commissioners (CCGs) following adv... |
6dbf405c32b6699f | #### In addition:
- If there is uncertainty about whether the woman is in established labour, a vaginal examination may be helpful after a period of assessment, but is not always necessary.
- If the woman appears to be in established labour, offer a vaginal examination. |
a97a9b960a83139a | ## Appendix F: Risk assessment, surveillance pathway and management of women at risk of preterm birth
This appendix describes a risk assessment, surveillance and management pathway for women at risk of preterm birth. It has been designed with reference to NICE guidance and the [UK Preterm Clinical Network guidance.](h... |
955e4249233ffc4e | #### **Prevention**
All women should be assessed at booking for risk factors for preterm birth. This assessment should include modification of population based risk factors acknowledging that the majority of preterm deliveries occur in women not appropriate for care in a preterm prevention clinic. |
0ecdc041f9931890 | #### **Prevention**
- 1. **Smoking cessation**: Smoking doubles the risk of preterm delivery and therefore all women should be asked about smoking, and cessation advice and/or referral should be provided. Women who have experienced a previous preterm birth, who stopped smoking early in the pregnancy, modify their risk... |
b08746ff5888820c | #### **Prevention**
- 2. **Maternal age**: Young women (<18 years) have an increased risk of preterm birth83. Appropriate referral to teenage pregnancy teams should be offered to provide adequate support and advice throughout the pregnancy and may help prevent preterm birth.
- 3. **Domestic violence**: Women experienc... |
0755219fcfe4de00 | #### **Prevention**
- 4. **Urinary tract infection (UTI)**: As indicated in NICE guidance84, midstream urine sample (MSU) should be taken and sent for culture and sensitivity in all pregnant women at booking. Culture positive samples, even in symptom-free women (asymptomatic bacteriuria), should be promptly treated. F... |
a8fa00db55670a1d | #### **Prevention**
- 5. **Vaginal infection**: Pathogens such as *Neisseria Gonorrhoeae* and *Chlamydia Trachomatis* are associated with preterm birth, and screening should be offered to at-risk women. In particular, healthcare professionals should inform pregnant women under the age of 25 years about the high preval... |
4d4cb33cd591e846 | #### **Prevention**
The role of organisms found in bacterial vaginosis (BV) remains controversial; the presence of BV is linked with preterm birth, but the varying methods used to ascertain its presence, and the timing and means of treatment in several studies have meant that no consensus currently exists as to its id... |
ce8dcc34ad06e54b | #### **Risk assessment**
The risk assessment should identify a group of high risk women who require management in a preterm birth prevention clinic where further tests may be offered as part of the surveillance pathway. This assessment should take place at the booking appointment with referral by 12 weeks.
Table 2 is... |
cdbcd03456616188 | #### **Risk factor Pathway High risk** • Previous preterm birth or mid-trimester loss (16 to 34 weeks gestation). • Previous preterm prelabour rupture of membranes <34/40. • Previous use of cervical cerclage. • Known uterine variant (i.e. unicornuate, bicornuate uterus or uterine septum). • Intrauterine adhesions (Ashe... |
9660245f79a34156 | #### **Risk factor Pathway High risk** • Previous preterm birth or mid-trimester loss (16 to 34 weeks gestation). • Previous preterm prelabour rupture of membranes <34/40. • Previous use of cervical cerclage. • Known uterine variant (i.e. unicornuate, bicornuate uterus or uterine septum). • Intrauterine adhesions (Ashe... |
9530d3392f826782 | #### **Intermediate risk**
- Previous delivery by caesarean section at full dilatation.
- History of significant cervical excisional event i.e. LLETZ where >10mm depth removed, or >1 LLETZ procedure carried out or cone biopsy (knife or laser, typically carried out under general anaesthetic). |
40aaff71fa6eda9e | #### **Surveillance**
- 1) Refer to preterm birth prevention clinic by 12 weeks.
- 2) Further risk assessment based on history +/- examination as appropriate in secondary care with discussion of option of additional risk assessment tests, including:
- a) A single transvaginal cervix scan between 18-22 weeks as a mini... |
760dc119de7eb880 | #### **Management**
- 3) Interventions should be discussed with women as appropriate based on either history or additional risk assessment tests by clinicians able to discuss the relevant risks and benefits according to up to date evidence and relevant guidance. These interventions should include cervical cerclage, pe... |
654177e4ef5220b9 | #### **Risk assessment**
Women with any of the additional high risk factors should be reviewed in a preterm birth prevention clinic where a detailed history should be obtained and an individualised plan made. Additional tests for ascertaining risk should be offered; as a minimum this should include transvaginal cervix... |
786238021372b338 | #### **Risk assessment**
The addition of a second risk assessment tool, quantitative fetal fibronectin, is currently being evaluated in symptomatic women in clinical studies. In asymptomatic women, this additional tool may be used from 18 weeks to ascertain risk of second trimester miscarriage or preterm birth in conj... |
8c8509acb166a9d0 | #### **Prevention**
After assessment within the preterm birth prevention clinic, women on the basis of history and/or additional risk assessment tools should be offered treatment to prevent second trimester miscarriage and preterm birth. |
ba2826cda1604e0d | #### **Prevention**
Several interventions have been assessed for women at high risk of preterm birth: cervical cerclage, progesterone and pessaries. Cervical cerclage is an established procedure, progesterone is recommended in certain situations by NICE, and there are randomised trials suggesting benefit in the use of... |
d1194d8f75f4b602 | #### **Prevention**
- **Women with a history of spontaneous preterm birth or late miscarriage (16-34 weeks)**:
- o Offer a history-indicated (planned, prophylactic, elective) cervical cerclage or transvaginal ultrasound surveillance of the cervix within the second trimester.
- o History-indicated cerclage should be ... |
b08cb81aa689ed69 | #### **Prevention**
- o The circumstances of the failed suture and other clinical factors should be considered prior to placement, and appropriately experienced clinicians should be involved in the decision making and surgery. High vaginal or transabdominal cerclage may be considered. Transabdominal placement during p... |
443c4ace43e7fe76 | #### **Prevention**
- o Care for these women should be individualised. Counselling should include options of continued surveillance or intervention with clinicians able to discuss the relevant risks and benefits according to up to date evidence and relevant guidance. These interventions should include cervical cerclag... |
9d7feb02e5553bde | #### **Prevention**
| routine pathways of care. Midwifery-led care are identified. | is appropriate | | if no other additional risk factors |
|-----------------------------------------------------------------|----------------|--|-------------------------------------|
| | | | |
| | | | |
| | | | |
| | | | | |
f3e5ff3daf314493 | #### **Prevention**
| routine pathways of care. Midwifery-led care are identified. | is appropriate | | if no other additional risk factors |
|-----------------------------------------------------------------|----------------|--|-------------------------------------|
| | | | |
| | | | | |
7df1d25b17ac0481 | # **Abortion care**
NICE guideline
Published: 25 September 2019
[www.nice.org.uk/guidance/ng140](https://www.nice.org.uk/guidance/ng140) |
0d3cb48d37952f8c | ## **Overview**
This guideline covers care for women of any age (including girls and young women under 18) who request an abortion. It aims to improve the organisation of services and make them easier for women to access. Detailed recommendations on conducting abortions at different gestational stages are also include... |
c5d9c315d0161754 | ### **Who is it for?**
- Healthcare professionals
- Commissioners and providers
- Those responsible for training curriculums
- Women requesting an induced abortion |
ebeca1cd4bbdec46 | # **Recommendations**
People have the right to be involved in discussions and make informed decisions about their care, as described in [NICE's information on making decisions about your](http://www.nice.org.uk/about/nice-communities/public-involvement/your-care) [care.](http://www.nice.org.uk/about/nice-communities/p... |
c573512a6b5b4083 | #### **Abortion Act 1967**
Providers of abortion services must comply with the Health and Social Care Act 2008 and regulations made under that Act. In particular, providers must register with the Care Quality Commission (CQC). This is because under section 10 of the Health and Social Care Act 2008, it is an offence to... |
3c208bd674689642 | #### **Gender**
This guideline makes recommendations for women and people who are pregnant. For simplicity of language the guideline uses the term women throughout, but this should be taken to also include people who do not identify as women but who are pregnant. |
203e160b2fc25d01 | ### **Making it easier to access services**
1.1.1 Commissioners and providers should work together to:
- make information about abortion services (including how to access them) widely available
- ensure that women are promptly referred onwards if a service cannot provide an abortion after a specific gestational age o... |
68fc8d1b377ebf06 | #### **Waiting times**
- 1.1.5 Commissioners should work with providers to ensure abortion services have the capacity and resources to deliver the range of services needed with minimal delay.
- 1.1.6 Ensure minimal delay in the abortion process, and ideally:
- provide the assessment within 1 week of the request
- pr... |
a0448d0c4c4887f2 | ### **Workforce and training**
- 1.1.11 Abortion providers should maximise the role of nurses and midwives in providing care.
- 1.1.12 Trainee healthcare professionals and students who may care for women who request an abortion (for example nurses, midwives, and GPs) should have the chance to gain experience in aborti... |
ebdf2e7e8eab5bc2 | ### **Complex comorbidities**
- 1.1.15 Specialist centres should be available as locally as possible, to reduce delays and travel times for women with complex needs or significant comorbidities.
- 1.1.16 Providers should develop pathways for women with complex needs or significant comorbidities to:
- refer them to sp... |
6e8207d806bc6b9b | ### **Avoiding stigma**
- 1.1.17 When caring for women who are having an abortion, be aware of:
- the anxiety they may have about perceived negative and judgemental attitudes from healthcare professionals
- the impact that verbal and non-verbal communication may have on them.
- 1.1.18 Services should be sensitive to... |
1782fafa6760896f | ## **1.2 Providing information**
- 1.2.1 Reassure women that having an abortion is not associated with increased risk of infertility, breast cancer or mental health issues.
- 1.2.2 Provide information about the differences between medical and surgical abortion (including the benefits and risks), taking account of the ... |
c5429c6226ffd06a | ## **1.2 Providing information**
- 1.2.4 Provide information in a range of formats, for example video or written information. Include information based on the experiences of women who have had an abortion.
- 1.2.5 For more guidance on providing information and helping women to make decisions about their care, see the ... |
e665c28026d620ac | ## **1.2 Providing information**
- what the products of pregnancy will look like and whether there may be any movement.
- 1.2.8 For women who are having a medical abortion at home, explain how to be sure that the pregnancy has ended (see follow-up after medical abortion up to and |
900e640aa09523a4 | #### including 10+0 weeks).
- 1.2.9 Provide women with information on signs and symptoms that indicate they need medical help after an abortion, and who to contact if they do.
- 1.2.10 Provide women with information about the different options for management and disposal of pregnancy remains. |
d39b91f844506117 | ## **1.3 Anti-D prophylaxis**
- 1.3.1 Offer anti-D prophylaxis to women who are rhesus D negative and are having an abortion after 10+0 weeks' gestation.
- 1.3.2 Do not offer anti-D prophylaxis to women who are having a medical abortion up
to and including 10+0 weeks' gestation.
- 1.3.3 Consider anti-D prophylaxis f... |
9ea92899ff999f3d | ## **1.4 Preventing infection**
- 1.4.1 Routinely offer and recommend a HIV test to women at their first appointment with abortion services, in line the [recommendations on secondary and](https://www.nice.org.uk/guidance/ng60/chapter/Recommendations#secondary-and-emergency-care) [emergency care in NICE's guideline on ... |
15d0fa209b3d4e66 | ## **1.4 Preventing infection**
- 1.4.3 Offer antibiotic prophylaxis to women who are having surgical abortion.
- 1.4.4 When using doxycycline for antibiotic prophylaxis in medical or surgical abortion, consider oral doxycycline 100 mg twice a day for 3 days.
- 1.4.5 When using metronidazole for antibiotic prophylaxis... |
7a21eabde25d5495 | ## **1.4 Preventing infection**
Full details of the evidence and the committee's discussion are in [evidence review](https://www.nice.org.uk/guidance/ng140/evidence/d-antibiotic-prophylaxis-for-medical-and-surgical-abortion-pdf-6905052976) D: [antibiotic prophylaxis for medical and surgical abortion.](https://www.nice... |
709e91e3a30b69fc | ## **1.5 Venous thromboembolism prophylaxis**
- 1.5.1 For women who need pharmacological thromboprophylaxis, consider low-molecular-weight heparin for at least 7 days after the abortion.
- 1.5.2 For women who are at high risk of thrombosis, consider starting low-molecular-weight heparin before the abortion and giving ... |
6b70809d2c7bd13a | ## **1.6 Choice of procedure for abortion**
- 1.6.1 Offer a choice between medical or surgical abortion up to and including 23+6 weeks' gestation (surgical abortion can be performed shortly after 23+6 weeks' gestation only if feticide is given at or before 23+6 weeks' gestation, according to the [2019 clarification of... |
806e59cad84d7282 | ## **1.6 Choice of procedure for abortion**
- 1.6.2 To help women decide between medical and surgical abortion, see the [NICE](https://www.nice.org.uk/guidance/ng140/resources/patient-decision-aids-and-user-guides-6906582256) [patient decision aids](https://www.nice.org.uk/guidance/ng140/resources/patient-decision-aid... |
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