1: Fertility Control - TOP

Question 1

What proportion of women will have had a TOP by age 45-years

Answer 1

1/3

Question 2

What two acts govern termination of pregnancy

Answer 2

1. The abortion act (1967, revised 2000)

2. Human Fertilisation and Embryo Act (1990)

Question 3

what are the. 5 clauses of the abortion act (2000)

Answer 3

A. Risk to mother’s life
B. Risk of grave physical or mental injury to mother
C. Risk of physical or mental injury to mother and foetus is less than 24W
D. Risk of physical of mental injury to other children of the mother and foetus is less than 24W
E. Child is likely to be born with serious mental or physical disorder causing them to be severely handicapped

Question 4

what is the time-limit for clauses A, B and E

Answer 4

No time limit

Question 5

what is the time limit for clauses C and D

Answer 5

24W

Question 6

what document must doctors sign to confirm criteria have been met

Answer 6

HSA1

Question 7

if more than 24W where must TOP be carried out

Answer 7

NHS Hospital

Question 8

explain obligation of doctors for TOP as set by GMC

Answer 8

• Do not let prejudice impact treatment

- Can refuse under conscientious objection, but refer to doctor who will

Question 9

explain TOP in patients under 16-years

Answer 9

Encourage to involve parents but can under Fraser competence

Question 10

explain what should be given before TOP

Answer 10

Counselling 
US - confirm gestation 
STI test
Antibiotic prophylaxis 
Anti-D if rhesus negative

Question 11

what medications are given in a medical termination

Answer 11

mifepristone and misprostol

Question 12

when is medical terminations effective

Answer 12

> 6W

Question 13

what are medical terminations typically used

Answer 13

second-trimester terminations

Question 14

when is the second trimester

Answer 14

13-28W

Question 15

if an early TOP what follow-up should be arranged

Answer 15

US scan at 2W to confirm success

Question 16

what is given alongside mifepristone and misoprostol for medical termination

Answer 16

Narcotics or NSAIDs for analgesia

Question 17

what defines an early medical termination

Answer 17

TOP before 9W

Question 18

explain an early medical termination

Answer 18

Give mifepristone (200mcg) and then misoprostol (400mcg) 24-48h later

Question 19

what should be done medical termination 9-13W

Answer 19

Give mifepristone (200mcg) and misoprostol (800mcg) 36-48h later

Question 20

what should be done for medical termination 13-24W

Answer 20

Give mifepristone (200mcg) and misoprostol (800mcg) 36-48h later

Question 21

what type of medication is mifepristone

Answer 21

anti-progesterone

Question 22

what is the MOA of mifepristone

Answer 22

1. Uterine contractions
2. Increases receptiveness uterus to PGs
3. Placental bleed

Question 23

what is misoprostol

Answer 23

PGEI analogue

Question 24

what is the MOA of misoprostol

Answer 24

Uterine contractions

Question 25

what are the two surgical methods of TOP

Answer 25

1. Suction | 2. Dilation and Evacuation

Question 26

when do individuals need cervical dilation

Answer 26

<18-years or >10W gestation

Question 27

what is used to cause cervical dilation prior to surgical TOP

Answer 27

gamoprost or misprostol

Question 28

what is gameprost

Answer 28

PGEI analogue

Question 29

when is misoprostol used as a cervical dilator

Answer 29

Up to 18W

Question 30

what is used above 14W as cervical dilator

Answer 30

Osmotic dilators

Question 31

If surgical TOP is performed >13W who should be performing it

Answer 31

Consultant - due to higher risks of perforation, bleeding and retained products

Question 32

Explain surgical management of TOP less than 7W

Answer 32

Do NOT use suction. Medical management preferred

Question 33

What method is used 7-13W for surgical management of TOP

Answer 33

Suction

Question 34

What is used >13W for surgical management TOP

Answer 34

Dilation and Evacuation

Question 35

What are risks of higher gestation TOP

Answer 35

- Bleeding - Uterine rupture - Retained products

Question 36

if gestation more than 21+6 what should happen to the foetus if TOP

Answer 36

Give intracardiac postassium chloride and foetus must be delivered

Question 37

what is used to cause TOP if foetus is more than 21+6

Answer 37

3mL 15% intracardiac potassium chloride

Question 38

what must be confirmed after intracranial potassium chloride

Answer 38

US to confirm systole

Question 39

if a foetus is more than 24W what does the foetus count as

Answer 39

stillbirth - needs a death certificate

Question 40

what are complications of TOP

Answer 40

``` Infection Haemorrhage Uterine perforation Uterine rupture Failure Retained products conception ```

Question 41

what causes higher failure rates medical or surgical TOP

Answer 41

Medical TOP

Question 42

what is used to prevent infection in TOP

Answer 42

Azithromycin and Metronidazole

Question 43

how does risk of haemorrhage change

Answer 43

Increases with gestation

Question 44

what can cause uterine rupture

Answer 44

Medical TOP - mid gestation

Question 45

what can cause uterine perforation

Answer 45

Surgical TOP

Question 46

if TOP less than 20W and rhesus negative what is given

Answer 46

250IU anti-D

Question 47

if TOP more than 20W and rhesus negative what is given

Answer 47

500IU anti-D