Question 9: TOP Flashcards
Under what circumstances can pregnancy be terminated up to 12 weeks gestation ?
Upon request of the woman.
Under what circumstances can pregnancy be terminated from 13- 20 weeks gestation ?
Risk of injury to mother’s physical/mental health.
Risk of severe fetal abnormality.
Pregnancy resulted from rape/incest.
Significant social/economic impact on the woman.
Under what circumstances can pregnancy be terminated after 20 weeks gestation ?
If two medical practitioners agree that pregnancy:
Endangers the woman’s life.
Would result in severe fetal malformation.
Poses a risk of injury to the fetus.
Who is allowed to perform a termination of pregnancy?
Registered medical practitioners.
Registered midwives (up to 12 weeks gestation, with prescribed training).
What are the methods for first-trimester termination (<14 weeks)?
Medical:
<9 weeks: Mifepristone → 48-72 hrs → Misoprostol.
9-14 weeks: Mifepristone → 48-72 hrs → Misoprostol (repeated every 3 hrs).
Surgical: Suction evacuation (STOP).
What is cervical priming, and why is it done?
Softens and dilates the cervix before a surgical procedure.
Uses Misoprostol (400-600mcg) 2-12 hrs before surgery.
What are the types of vacuum pumps used in suction evacuation?
Manual vacuum aspiration (MVA).
Foot pump.
Electrical suction pump.
What are the methods of termination in the second trimester (>14 weeks)?
Medical:
Mifepristone → 48-72 hrs → Misoprostol every 3 hrs until abortion occurs.
Uterine evacuation if placenta is retained.
Surgical:
Dilation & Embryotomy (D+E).
Hysterotomy (removal of fetus from uterus).
What analgesia options are used in first-trimester TOP?
on-pharmacological support.
Paracervical block.
Indomethacin suppositories.
Conscious sedation (Midazolam + Fentanyl).
General anesthesia (if needed).
What analgesia is needed for second-trimester TOP?
Stronger pain relief (Opiates, Epidural).
Usually done as an inpatient.
What are short-term complications of TOP?
Hemorrhage.
Sepsis.
Retained products of conception.
Trauma (uterine perforation/rupture).
Anesthetic complications.
Drug reactions (e.g., prostaglandins).
What are long-term complications of TOP?
Cervical incompetence.
Preterm labor.
Chronic pelvic pain.
Infertility (due to infection).
Depression.
What investigations should be done before the procedure?
Hemoglobin (Hb).
HIV & VDRL.
Rhesus grouping.
Pap smear.
What care is needed after the procedure?
Anti-D immunoglobulin (if Rhesus-negative).
Broad-spectrum antibiotics for second-trimester TOP (Doxycycline, Cefixime, Metronidazole).
What should a healthcare provider do if they object to performing a TOP?
Refer the patient to a provider who will perform the procedure.
Cannot obstruct, delay, or withhold information—this violates patient rights.
