Early Pregnancy - Termination of Pregnancy (TOP)

Question 1

What is a Termination of Pregnancy (TOP)?

Answer 1

An abortion, an elective procedure to end a pregnancy.

Question 2

Legal Framework of TOPs.

Answer 2

1. 1967 Abortion Act.
2. 1990 Human Fertilisation and Embryology Act (alteredand expanded the initial criteria for an abortion and reduced the latest stage from 28 weeks to 24 weeks).

Question 3

Why can a TOP be performed before 24 weeks?

Answer 3

If continuing the pregnancy involves greater risk to the physical or mental health of the woman or existing children of the pregnancy.

Question 4

Why can a TOP be performed at any time during the pregnancy? (3)

Answer 4

1. Continuing the pregnancy is likely to risk the life of the woman.
2. Terminating the pregnancy will prevent ‘grave permanent injury’ to the physical or mental health of the woman.
3. ‘Substantial risk’ that the child would suffer physical or mental abnormalities, making it seriously handicapped.

Question 5

Legal Requirements of a TOP (2).

Answer 5

1. 2 registered medical practitioners must sign to agree that the abortion is indicated (in an emergency, only 1).
2. Carried out by a registered medical practitioner in an NHS Hospital or approved premise.

Question 6

Medical TOPs (4).

• Treatment 1.
• Treamtent 2.
• Prophylaxis.
• Use.

Answer 6

1. Mifepristone (Anti-Progestogen) blocks the action of Progesterone to halt the pregnancy and relax the cervix.
2. Misoprostol (Prostaglandin analogue) softens the cervix and stimulates uterine contractions 1-2 days later (additional doses are required if after week 10).
3. Anti-D Prophylaxis for Rhesus Negative Women.
4. More appropriate earlier in pregnancy (but can be used at any gestation).

Question 7

Surgical TOPs (4).

Answer 7

1. Prior to surgical TOP, medications are used for cervical priming to soften and dilate the cervix : Misoprostol, Mifepristone and Osmotic Dilators.
2. Method 1 : Cervical Dilation and Suction of Contents of Uterus (Before Week 14).
3. Method 2 : Cervical Dilation and Evacuation Using Forceps (14-24 Weeks) after inducing a ‘mini-labour’.
4. Anti-D Prophylaxis for Rhesus Negative Women.

Question 8

What is an Osmotic Dilator?

Answer 8

Device inserted into the cervix to gradually expand as they absorb fluid and open the cervical canal.

Question 9

Post-Abortion Care (2).

Answer 9

1. Vaginal Bleeding and Intermittent Abdominal Cramps for up to 2 Weeks After.
2. Urine Pregnancy Test 3 Weeks Later to Confirm.

Question 10

Complications of TOPs (5).

Answer 10

1. Bleeding.
2. Pain.
3. Infection.
4. Failure of Abortion (Pregnancy).
5. Damage to Cervix, Uterus and Other Structures.