Gynaecology: Termination of pregnancy

Question 1

When was the Abortion act created?

Answer 1

1967

Question 2

What is the upper ls the upper limit of abortion

Answer 2

states the upper limit of abortion is < 24wks

Question 3

Explain the process of termination of pregnancy

Answer 3

1. Pregnancy test - must be +ve
2. USS - must detect foetal HR (usually present > 6wks)
3. STI screen
4. Blood group - give Anti-D (if <12wks 250, if > 12wks 500)
5. Referral to aboriton clinic - must be by 2 doctors
6. Prophylactic Abx - Metronidazole (1g PR, 900mg PO) and Doxycycline (!00mg BD 7d)
7. Analgesia - NSAIDs
8. Method of TOP depends on gestational age and mothers choice

MEDICAL
a. <9wks Early medical abortion - mifepristone (600mg) and misoprostol (1mg) 24-48hrs later

b. 21+6wks any intervention must involve feticide - potassium chloride

SURGICAL
a. Manual vacuum aspiration (MVA) 9-12 wks

b. Surgical dilatation and uterine content evacuation
c. Late medical abortion - involves inducing labour if > 15wks
d. Surgery with foeticide at 22-24 wks
e. Surgical termination of pregnancy (STOP) - used for incomplete or failed TOP

Question 4

What are the factors and management options to consider after TOP?

Answer 4

Anti-D to all non-sensitised patients

Contraception

Question 5

What are the exceptions to abortion if post-24 weeks?

Answer 5

There is no upper limit to the time If there is risk of:

• life threatening risk to mother
• grave or permanent injury to physical or emotional health of mother
• substantial physical or mental abnormalities that would cause disability (handicap) - must be done in NHS hospital