6.4 - Termination of Pregnancy

Question 1

If a women wants termination who performs the termination of pregnancy?

Answer 1

GP/OPD if <10 weeks (9+6
Hospital is 10+ weeks

Question 2

Why should termination of pregnancy be done in a hospital starting 10 weeks

Answer 2

Risk of rhesus isoimmunization is very low before 10 weeks => starting 10 weeks, monitoring is required as the risk increases dramatically

Question 3

When prescribing a dose of Anti-D for rhesus isoimmunization, how much?

Answer 3

1500 units

Question 4

What should be done before termination of pregnancy?

Answer 4

Counselling +/- social services if needed
Bloods especially for determining rhesus status of mother
Intracardiac KCl
Cervical cytology
Ultrasound

Question 5

What are the methods of termination of pregnancy
Discuss 1 advantage and disadvantage of each

Answer 5

Medical: 98% success rate: PO 200mg Mifepristone (progesterone antagonist) followed by PV/buccal 800mcg Misoprostol (prostaglandin agonist)
Advantages: Patient-controlled, no operative risk, less costly,
Disadvantages: Heavy prolonged menorrhea and dysmenorrhea

Surgical: 1 dose antibiotic prophylaxis (for every surgery)
If <12 weeks Misoprostol followed by suction curettage (not evacuation)
If >12 weeks Dilatation and evacuation
Advantage: Less prolonged bleeding and pain, gets it over with
Disadvantage: Operative risks and costs

+!!!Anti D since bleeding involved
+!!! Follow up after 1 week (even if you dont know the followup of anything, you must always offer 1-2 weeks followup)
+ Offer contraception

Question 6

What is the effect of medical and surgical management in TOP on future pregnancies?

Answer 6

There is no evidence to show increased association between TOP and ectopics, placenta praevia or infertility

There is a small increased risk of subsequent miscarriage

Question 7

What is your full management plan in the termination of pregnancy

Answer 7

Counselling +/- social services if needed
Bloods especially for determining rhesus status of mother
Intracardiac KCl
Cervical cytology
Ultrasound

Medical: 98% success rate: PO 200mg Mifepristone (progesterone antagonist) followed by PV/buccal 800mcg Misoprostol (prostaglandin agonist)
Advantages: Patient-controlled, no operative risk, less costly,
Disadvantages: Heavy prolonged menorrhea and dysmenorrhea

Surgical: 1 dose antibiotic prophylaxis (for every surgery)
If <12 weeks Misoprostol followed by suction curettage (not evacuation)
If >12 weeks Dilatation and evacuation
Advantage: Less prolonged bleeding and pain, gets it over with
Disadvantage: Operative risks and costs

+!!!Anti D since bleeding involved
+!!! Follow up after 1 week (even if you dont know the followup of anything, you must always offer 1-2 weeks followup)
+ Offer contraception