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["Baseline assessment: Abortion care"]
["NG140"]
[]
[]
["Published: 25 September 2019"]

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[null,"Baseline assessment tool for abortion care (NICE guideline NG140)"]
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[null,"This baseline assessment tool can be used to evaluate whether practice is in line with the recommendations in Abortion care.  It can also help to plan activity to meet the recommendations."]
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[null,"The tool can be used by individual services or organisations. Alternatively, an assessment completed with the involvement of all relevant services or organisations would help to develop a picture of activity in the local area."]
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[null,"It should be used in conjunction with Abortion care (NICE guideline NG140)."]
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[null,"In the first instance, consider whether the guideline is relevant and record the conclusion in the box below."]
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[null,"Is the guideline relevant?"]
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[null,"The data sheet contains the recommendations from the guideline. Information can be entered about current activity relevant to the recommendation, actions needed to meet the recommendation, deadlines and the names of the responsible leads.  Useful documents can be added as hyperlinks."]
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[null,"The table can be adapted to include any other local information that is thought to be useful."]
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[null,"If it would be helpful to group the recommendations, for example those that are key priorities for implementation or by deadline, use the filter function in the data menu. "]
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[null,"Tools and resources to help put the guidance into practice are available on the NICE website. "]
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[null,"National Institute for Health and Care Excellence\nLevel 1A, City Tower, Piccadilly Plaza, Manchester M1 4BT; www.nice.org.uk\n\nCopyright\n© NICE 2022. All rights reserved. Subject to Notice of rights.\n"]

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["Baseline assessment tool for abortion care (NICE guideline NG140)"]
[]
[null,null,null,"Number of relevant recommendations",{"$f":"COUNTIF(C8:C116,\"Yes\")","v":0}]
[null,null,null,"Number of recommendations met",{"$f":"COUNTIF(E8:E116,\"Yes\")","v":0}]
[null,null,null,"Percentage of recommendations met",{"$f":"IF(ISERROR(E4/E3),\"\",E4/E3)","v":""}]
[]
["NICE recommendation","Guideline reference","Is the recommendation relevant?","Current activity/evidence","Recommendation met?","Actions needed to implement recommendation","Is there a risk associated with not implementing this recommendation?","Is there a cost or saving?","Deadline","Lead"]
["1.1  Service organisation"]
["Making it easier to access services"]
["Commissioners and providers should work together to:\n•\tmake information about abortion services (including how to access them) widely available\n•\tensure that women are promptly referred onwards if a service cannot provide an abortion after a specific gestational age or by the woman’s preferred method\n•\tavoid the need for women to repeat key steps (such as returning to their GP for referral, or repeated assessments or investigations).","1.1.1"]
["Commissioners and providers should allow women to self-refer to abortion services.","1.1.2"]
["Healthcare professionals should not allow their personal beliefs to delay access to abortion services.","1.1.3"]
["Commissioners should consider upfront funding for travel and accommodation for women who:\n•\tare eligible for the NHS Healthcare Travel Costs Scheme and/or\n•\tneed to travel to a service that is not available locally.\nCommissioners should make information available about any upfront funding to access services.","1.1.4"]
["Waiting times"]
["Commissioners should work with providers to ensure abortion services have the capacity and resources to deliver the range of services needed with minimal delay.","1.1.5"]
["Ensure minimal delay in the abortion process, and ideally:\n•\tprovide the assessment within 1 week of the request \n•\tprovide the abortion within 1 week of the assessment. ","1.1.6"]
["For women who would prefer to wait longer for an abortion, help them to make an informed decision by explaining the implications, including:\n•\tthe legal limit for abortions, as stated in the Abortion Act\n•\tthat delaying the abortion will increase the risk of complications, although the overall risk is low.","1.1.7"]
["Do not require women to have compulsory counselling or compulsory time for reflection before the abortion. Provide or refer women for support to make a decision if they request this.","1.1.8"]
["Location of services"]
["Consider providing abortion assessments by phone or video call, for women who prefer this.","1.1.9"]
["Consider providing abortion services in a range of settings (including in the community and in hospitals), to meet the needs of the local population.","1.1.10"]
["Workforce and training"]
["Abortion providers should maximise the role of nurses and midwives in providing care.","1.1.11"]
["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 abortion services during their training.","1.1.12"]
["For specialities that include training in abortion as part of the core curriculum:\n•\tensure all trainees have the training, unless they opt out due to a conscientious objection\n•\tinclude practical experience of abortion services and procedures in the curriculum.","1.1.13"]
["If a trainee’s placement service does not provide abortions, the trainee should gain experience with whoever is providing this service (either in the NHS or in the independent sector).","1.1.14"]
["Complex comorbidities"]
["Specialist centres should be available as locally as possible, to reduce delays and travel times for women with complex needs or significant comorbidities.","1.1.15"]
["Providers should develop pathways for women with complex needs or significant comorbidities to:\n•\trefer them to specialist centres if needed\n•\tminimise delays in accessing care.","1.1.16"]
["Avoiding stigma"]
["When caring for women who are having an abortion, be aware of: \n•\tthe anxiety they may have about perceived negative and judgemental attitudes from healthcare professionals \n•\tthe impact that verbal and non-verbal communication may have on them. ","1.1.17"]
["Services should be sensitive to the concerns women have about their privacy and confidentiality, including their concerns that information about the abortion might be shared with healthcare professionals not directly involved in their care.","1.1.18"]
["1.2   Providing information"]
["Reassure women that having an abortion is not associated with increased risk of infertility, breast cancer or mental health issues.","1.2.1"]
["Provide information about the differences between medical and surgical abortion (including the benefits and risks), taking account of the woman’s needs and preferences. Do this without being directive, so that women can make their own choice.","1.2.2"]
["As early as possible, provide women with detailed information to help them prepare for the abortion. Cover: \n•\twhat it involves and what happens afterwards\n•\thow much pain and bleeding to expect.","1.2.3"]
["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.","1.2.4"]
["For more guidance on providing information and helping women to make decisions about their care, see the NICE guideline on patient experience in adult NHS services.","1.2.5"]
["Ask women if they want information on contraception, and if so provide information about the options available to them (see improving access to contraception).","1.2.6"]
["For women who are having a medical abortion, explain: \n•\tthat they may see the products of pregnancy as they are passed \n•\twhat the products of pregnancy will look like and whether there may be any movement.","1.2.7"]
["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 including 10+0 weeks).","1.2.8"]
["Provide women with information on signs and symptoms that indicate they need medical help after an abortion, and who to contact if they do.","1.2.9"]
["Provide women with information about the different options for management and disposal of pregnancy remains.","1.2.10"]
["Information for women who are having an abortion because of fetal anomaly"]
["If a woman who is having an abortion for fetal anomaly cannot have her preferred method of abortion in the maternity service, establish a clear referral pathway with ongoing communication between services so that she can:\n•\teasily transfer to the abortion service\n•\treceive ongoing support from the maternity service\n•\tget more information about the anomaly. ","1.2.11"]
["Explain to women that there may not be any physical signs of a fetal anomaly.","1.2.12"]
["1.3   Anti-D prophylaxis "]
["Offer anti-D prophylaxis to women who are rhesus D negative and are having an abortion after 10+0 weeks’ gestation.","1.3.1"]
["Do not offer anti-D prophylaxis to women who are having a medical abortion up to and including 10+0 weeks’ gestation.","1.3.2"]
["Consider anti-D prophylaxis for women who are rhesus D negative and are having a surgical abortion up to and including 10+0 weeks’ gestation.","1.3.3"]
["Providers should ensure that:\n•\trhesus status testing and anti-D prophylaxis supply does not cause any delays to women having an abortion \n•\tanti-D prophylaxis is available at the time of the abortion. ","1.3.4"]
["1.4   Preventing infection"]
["For guidance on testing for sexually transmitted infections for women who are having an abortion, see the NICE guideline on preventing sexually transmitted infections and under-18 conceptions.","1.4.1"]
["Do not routinely offer antibiotic prophylaxis to women who are having a medical abortion.","1.4.2"]
["Offer antibiotic prophylaxis to women who are having surgical abortion.","1.4.3"]
["When using doxycycline for antibiotic prophylaxis in medical or surgical abortion, consider oral doxycycline 100 mg twice a day for 3 days.","1.4.4"]
["When using metronidazole for antibiotic prophylaxis in medical or surgical abortion, do not routinely offer it in combination with another broad-spectrum antibiotic such as doxycycline.","1.4.5"]
["1.5   Venous thromboembolism prophylaxis "]
["For women who need pharmacological thromboprophylaxis, consider low‑molecular‑weight heparin for at least 7 days after the abortion.","1.5.1"]
["For women who are at high risk of thrombosis, consider starting low‑molecular‑weight heparin before the abortion and giving it for longer afterwards.","1.5.2"]
["1.6   Choice of procedure for abortion"]
["Offer a choice between medical or surgical abortion up to and including 23+6 weeks’ gestation. If any methods would not be clinically appropriate, explain why.","1.6.1"]
["To help women decide between medical and surgical abortion, see the NICE decision aid  on choosing medical or surgical abortion.","1.6.2"]
["1.7  Abortion before definitive ultrasound evidence of an intrauterine pregnancy "]
["Consider abortion before there is definitive ultrasound evidence of an intrauterine pregnancy (a yolk sac) for women who do not have signs or symptoms of an ectopic pregnancy.","1.7.1"]
["For women who are having an abortion before there is definitive ultrasound evidence of an intrauterine pregnancy (a yolk sac): \n•\texplain that there is a small chance of an ectopic pregnancy\n•\texplain that they may need to have follow-up appointments to ensure the pregnancy has been terminated and to monitor for ectopic pregnancy\n•\tprovide 24 hour emergency contact details, and advise them to get in contact immediately if they develop symptoms that could indicate an ectopic pregnancy (see symptoms and signs of ectopic pregnancy and initial assessment in the NICE guideline on ectopic pregnancy and miscarriage). ","1.7.2"]
["1.8    Expulsion at home for medical abortion up to and including 10+0 weeks"]
["Up to and including 9+6 weeks’ gestation"]
["For women who are having a medical abortion and will be taking the mifepristone up to and including 9+6 weeks’ gestation, offer the option of expulsion at home. Mifepristone and misoprostol can be taken at home or in the clinic or hospital.\n\nThis recommendation is based on the evidence for the safety of home expulsion. The legal limit for the gestational age at which mifepristone and misoprostol can be taken at home is specified in the Abortion Act 1967.","1.8.1"]
["At 10+0 weeks’ gestation"]
["For women who are having a medical abortion and will be taking the mifepristone at 10+0 weeks’ gestation, offer the option of expulsion at home after they have taken the misoprostol. Misoprostol can be taken in the clinic or hospital.","1.8.2"]
["1.9   Medical abortion up to and including 10+0 weeks "]
["See Table 1 for UK marketing authorisations for mifepristone and misoprostol for medical abortion."]
["Offer interval treatment (usually 24 to 48 hours) with mifepristone and misoprostol to women who are having a medical abortion up to and including 10+0 weeks’ gestation. ","1.9.1"]
["For women who are having a medical abortion up to and including 9+0 weeks’ gestation, give them the choice of having mifepristone and vaginal misoprostol at the same time, but explain that:\n•\tthe risk of ongoing pregnancy may be higher, and it may increase with gestation\n•\tit may take longer for the bleeding and pain to start \n•\tit is important for them to complete the same follow-up programme that is recommended for all medical abortions up to and including 10+0 weeks (recommendations 1.14.1 and 1.14.2).","1.9.2"]
["1.10    Medical abortion between 10+1 and 23+6 weeks "]
["See Table 1 for UK marketing authorisations for mifepristone and misoprostol for medical abortion."]
["For women who are having a medical abortion between 10+1 and 23+6 weeks’ gestation and who have taken 200 mg mifepristone, offer an initial dose (36 to 48 hours after the mifepristone) of:\n•\t800 micrograms misoprostol, given vaginally, or\n•\t600 micrograms of misoprostol4, given sublingually, for women who decline vaginal misoprostol.\nFollow the initial dose with 400 microgram doses of misoprostol (vaginal, sublingual or buccal), given every 3 hours until expulsion.","1.10.1"]
["Use a shorter interval between mifepristone and misoprostol if the woman prefers this, but explain that it may take a longer time from taking the first misoprostol dose to complete the abortion.","1.10.2"]
["1.11    Medical abortion after 23+6 weeks"]
["See Table 1 for UK marketing authorisations for mifepristone and misoprostol for medical abortion."]
["For women who are having a medical abortion between 24+0 and 25+0 weeks’ gestation, consider 200 mg oral mifepristone, followed by 400 micrograms misoprostol (vaginal, buccal or sublingual) every 3 hours until delivery.","1.11.1"]
["For women who are having a medical abortion between 25+1 and 28+0 weeks’ gestation, consider 200 mg oral mifepristone, followed by 200 micrograms misoprostol (vaginal, buccal or sublingual) every 4 hours until delivery.","1.11.2"]
["For women who are having a medical abortion after 28+0 weeks’ gestation, consider 200 mg oral mifepristone, followed by 100 micrograms misoprostol (vaginal, buccal or sublingual) every 6 hours until delivery.","1.11.3"]
["Be aware that: \n•\tthe uterus is more sensitive to misoprostol as pregnancy advances \n•\trisk factors for uterine rupture include a pre-existing uterine scar, increased gestational age and multiparity.","1.11.4"]
["1.12   Cervical priming before surgical abortion "]
["See Table 1 for UK marketing authorisations for mifepristone and misoprostol for medical abortion."]
["Up to and including 13+6 weeks "]
["For women who are having a surgical abortion up to and including 13+6 weeks’ gestation, offer cervical priming with:\n•\t400 micrograms sublingual misoprostol, given 1 hour before the abortion or\n•\t400 micrograms vaginal misoprostol, given 3 hours before the abortion.\nIf misoprostol cannot be used, consider cervical priming with 200 mg oral mifepristone, given 24 to 48 hours before the abortion.","1.12.1"]
["Explain to women that cervical priming:\n•\treduces the risk of incomplete abortion for women who are parous\n•\tmakes dilation easier for women who are parous or nulliparous\n•\tmay cause bleeding and pain before the procedure. ","1.12.2"]
["Between 14+0 and 23+6 weeks "]
["For women who are having a surgical abortion between 14+0 and 23+6 weeks’ gestation, offer cervical priming.","1.12.3"]
["For women who are having a surgical abortion between 14+0 and 16+0 weeks’ gestation, consider:\n•\tosmotic dilators or\n•\tbuccal, vaginal or sublingual misoprostol or\n•\t200 mg oral mifepristone, given the day before the abortion.","1.12.4"]
["For women who are having a surgical abortion between 16+1 and 19+0 weeks’ gestation, consider:\n•\tosmotic dilators or\n•\tbuccal, vaginal or sublingual misoprostol.","1.12.5"]
["For women who are having a surgical abortion between 19+1 and 23+6 weeks’ gestation, offer osmotic dilators. In addition, consider:\n•\t200 mg oral mifepristone the day before the abortion and \n•\tinserting osmotic dilators at the same time as the mifepristone.","1.12.6"]
["For women who are having a surgical abortion between 14+0 and 23+6 weeks’ gestation and are having cervical priming with osmotic dilators, consider inserting the osmotic dilators the day before the abortion.","1.12.7"]
["Do not offer misoprostol for cervical priming if the woman has had an osmotic dilator inserted the day before the abortion.","1.12.8"]
["1.13    Anaesthesia and sedation for surgical abortion "]
["For women who are having surgical abortion, consider local anaesthesia alone, conscious sedation with local anaesthesia, deep sedation or general anaesthesia. To help women make an informed choice, discuss the options with them and explain that: \n•\thaving local anaesthesia alone means they will be able to spend less time in hospital\n•\tintravenous sedation plus local anaesthesia will help if they are anxious about the procedure\n•\twith deep sedation or general anaesthesia they will not usually be aware during the procedure.","1.13.1"]
["When using conscious sedation for a surgical abortion, use intravenous rather than oral sedation.","1.13.2"]
["When using general anaesthesia for a surgical abortion, consider intravenous propofol and a short-acting opioid (such as fentanyl) rather than inhalational anaesthesia.","1.13.3"]
["1.14    Follow-up and support after an abortion "]
["Follow-up after medical abortion up to and including 10+0 weeks "]
["For women who have had a medical abortion up to and including 10+0 weeks’ gestation with expulsion at home, offer the choice of self-assessment, including remote assessment (for example telephone or text messaging), as an alternative to clinic follow-up.","1.14.1"]
["Provide women with a low-sensitivity or multi-level urine pregnancy test to exclude an ongoing pregnancy.","1.14.2"]
["Support after an abortion"]
["Explain to women:\n•\twhat aftercare and follow-up to expect\n•\twhat to do if they have any problems after the abortion, including how to get help out of hours\n•\tthat it is common to feel a range of emotions after the abortion.","1.14.3"]
["Advise women to seek support if they need it, and how to access it (if relevant). This could include:\n•\tsupport from family and friends or pastoral support\n•\tpeer support, or support groups for women who have had an abortion\n•\tcounselling or psychological interventions.","1.14.4"]
["Providers should be able to provide emotional support after abortions. They should tell women this support is available if they need it.","1.14.5"]
["Providers should provide or refer women for counselling if requested.","1.14.6"]
["1.15   Improving access to contraception "]
["Commissioners and providers should ensure that the full range of reversible contraceptive options (depot medroxyprogesterone acetate [DMPA], contraceptive implant, intrauterine methods, oral contraceptives, contraceptive patches, vaginal rings or barrier contraception) is available for women on the same day as their surgical or medical abortion.","1.15.1"]
["Providers should ensure that healthcare professionals have the knowledge and skills to provide all contraceptive options.","1.15.2"]
["Providers should ensure they can provide the contraceptive implant, and that women who choose this method are offered it on: \n•\tthe day of the surgical abortion or \n•\tthe day they take mifepristone (for medical abortions). ","1.15.3"]
["Providers should ensure they can provide intrauterine methods of contraception, and that women who choose this method are offered this:\n•\tat the same time as the surgical abortion or \n•\tas soon as possible after expulsion of the pregnancy (for medical abortions). ","1.15.4"]
["For women who are having a medical abortion and who choose DMPA intramuscular injection for contraception: \n•\tconsider providing it at the same appointment when they take the mifepristone \n•\texplain that having the injection at this stage may increase the risk of ongoing pregnancy, although overall the risk is low. ","1.15.5"]

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["UK marketing authorisations for mifepristone and misoprostol for medical abortion"]
["In September 2019, mifepristone for abortion only has a UK marketing authorisation for:\n"]
["·     600 mg orally for medical abortion of developing intrauterine pregnancy, followed 36 to 48 hours later by 400 micrograms misoprostol orally or 1 mg gemeprost vaginally, up to and including 49 days of amenorrhoea"]
["·     600 mg orally for medical abortion of developing intrauterine pregnancy, followed 36 to 48 hours later by 1 mg gemeprost vaginally, between 50 days and 63 days of amenorrhoea"]
["·     200 mg orally for medical abortion of developing intrauterine pregnancy, followed 36 to 48 hours later by 1 mg gemeprost vaginally, between 50 days and 63 days of amenorrhoea"]
["·     200 mg orally for medical abortion of developing intrauterine pregnancy, followed 36 to 48 hours later by 800 micrograms misoprostol vaginally, up to and including 63 days of amenorrhoea"]
["·     600 mg orally for medical abortion for medical reasons, followed 36 to 48 hours later by prostaglandin administration, beyond the first trimester"]
["·     200 mg orally for cervical priming, 36 to 48 hours before first trimester surgical abortion.\n"]
["All other uses of mifepristone are off label. See NICE’s information on prescribing medicines."]
["In September 2019, misoprostol for medical abortion only has a UK marketing authorisation for:"]
["·     400 micrograms orally as an initial dose for medical abortion of developing intrauterine pregnancy, 36 to 48 hours after 600 mg mifepristone orally, up to and including 49 days of amenorrhoea"]
["·     800 micrograms vaginally as an initial dose for medical abortion of developing intrauterine pregnancy, 36 to 48 hours after 200 mg mifepristone orally, up to and including 63 days of amenorrhoea.\n"]
["All other uses of misoprostol (including for cervical priming and for abortion at later gestations) are off label. See NICE’s information on prescribing medicines."]