PREGANCY TERMINATION Flashcards
What is the law in SA?
Can’t terminate after 28 weeks ever
If life threatening, can terminate without 2nd opinion
Otherwise always 2 doctors needed to confirm
What are indications for termination?
Medical
- save woman’s life
- risk of delivery > risk of termination
- genetic defect e.g. Anencephaly
Social reasons
Indication for surgical termination? What counselling?
Done in 1st trimester
Gestational age < 12 weeks
Risk of procedure + informed consent
Consent for IUD contraception after surgical termination
Swab for STI
Process of surgical termination?
Fast 6hours
Pre-op misoprostol for preparing cervix
Supportive
- antiemetic
- analgesic
Operative
- vaccum auction for termination of pregnancy (VSTOP)
- US
- local anaesthetic
- vacuum suction or D&C
Post- op
- monitor vitals and PV Blood loss
- discharge after a couple of hours if stable and has adult to take home
- return to women’s assessment unit if wise a
Complications of VSTOP?
Endometritis is MC
Uterine perforation
Fistula to bowel or bladder
When would you do medical termination? Contraindications?
Usually 2nd trimester, can be first
Pt must be able to follow up and have support available if profuse bleeding occurs at home.
Contraindications
- bleeding diatheses
- IUD in situ
- pid
- ectopic
- adrenal failure (mifepristone suppresses adrenal function)
Process of medical termination?
PO mifepristone
After 1-2 days, buccal or sublingual misoprostol
Pass products of conception in next few hours, but bleeding occurs for weeks
If Rh-ve, give anti-D
Supportive medication: analgesia and anti-emetic
Self administer misoprostol
Follow up, termination successful if:
- Sx subside
- beta HCG levels
- US uterus if doubt
- next nenstrual period in 5 weeks
Complications of medical termination?
Failed top
Retained products of conception, further misoprostol
Haemorrhage, needs ready D&C.
Infection is rare
