Down's Syndrome Screening and Termination of Pregnancy

Question 1

What is involved in combined T1 screening? When does it occur?

Answer 1

• T1 screening (9 weeks to 13+6 weeks)
  
  • PAPP-A, bHCG
  • Ultrasound (11 - 13+6) for nuchal translucency
  • Maternal age

Question 2

What is involved in T2 screening during pregnancy? When does it occur?

Answer 2

• T2 (14-18 weeks)
  
  • Estriol, bHCG, PAPP-A, aFP

Question 3

When can CVS and amniocentesis each be performed? What are the risks?

Answer 3

• Amniocentesis (15-18 weeks)
  
  • Risk of miscarriage less than 1 in 200 (similar to background risk)
• CVS (11-14 weeks)
  
  • Risk of miscarriage less than 1 in 100

Question 4

In preparing with a woman for termination of pregnancy, what elements need to be considered?

Answer 4

• Confirmation and assessment of pregnancy (history, examination, investigations - ultrasound)
  
  • Ruling out non-pregnancy, ectopic
• Assessment of surgical and medical risk
  
  • Choice of method
• Blood group and antibodies (anti-D requirement)
• STI status or prophylactic antibiotics
• Ongoing contraception planning
• Follow-up (counselling, contraception)

Question 5

In Victoria, up to what point can unwanted pregnancies be terminated?

Answer 5

• 24 weeks
• After this - requires two doctors to sign off as appropriate to circumstances and health
• Practitioners are obliged (if conscientious objector) to refer women on to someone who is not

Question 6

How is medical termination of pregnancy undertaken?

Answer 6

• Antigestogen (mifepristone - releases foetus from implantation) followed by a 48 hours later prostaglandin (misoprostol)
• Pain and bleeding often felt within a few hours of PG
• Side-effects
  
  • Pain (NSAIDs usually sufficient)
  • Nausea and vomiting (PGs)

Question 7

What are the complications relevant to medical termination of pregnancy?

Answer 7

• Haemorrhage (1-2 in 1000)
• Infection (1%)
• Requirement for surgical clearance (5%, if failure or incomplete)

Question 8

What are the available methods for surgical termination of pregnancy? When are they generally utilised?

Answer 8

• Vacuum aspiration
  
  • Used in first trimester pre-7 weeks
• Suction curette
  
  • Used up to 14-15 weeks gestation
• Dilation and evacuation
  
  • Used after 14-15 weeks

Question 9

What is the most common side-effect of surgical termination of pregnancy? What are the relevant complications?

Answer 9

• Side effects:
  
  • Mild pain and bleeding 2-3 weeks
  • Oral analgesia usually sufficient - NSAID
• Complications
  
  • Repeat required (1-2%)
  • Cervical trauma (< 10 in 1000)
  • Perforation (1-4 in 1000)
  • Infection (5-12 in 1000)
  • Haemorrhage requiring transfusion (0.5-2 in 1000)
  • Mortality (1 in 100000)