Gyn TOP

Question 1

What is the medical management of TOP

Answer 1

mifepristone oral, followed by 24/48h later misoprostol (vaginal)
take 4pills, and 4h later expect 4h of bleed/pain

give abx

can be used anytime, but need increased dose of misoporstol after 9w
<9w can be done at home, after better in clinical

and if over 22w- feticide- intracardiac KCL to kill baby

Question 2

What are the surgical mx of TOP

Answer 2

<14w- vacuum aspiration of foetus under local or general
+misoporstol to prepare cercix
+ abx

> 14w - dilation and evacuation (D&E)
required to remove larger parts + misoprostol added/ USS to confirm

can fail, bleed, infection, perforate
no effect on future reprodcution