Termination Flashcards
How many terminations were there in 2012?
185,122 residents, 5,850 non-residents - mostly irish = 190,972
97% NHS funded
Highest rates are in southwark, lambeth and lewisham
When do terminations happen?
91% are before 13 weeks
77% are before 10 weeks
Only 160 were after 24 weeks
82 were selective terminations - 76% under ground E, 38 cases of twins to singleton
Terminations due to fetal abnormality
2,692 in 2012 –> 38% were chromosomal abnormalities
Methods of termination
52% were surgical – vacuum from 4-16weeks, dilation & evacuation 13 to 24 weeks
48% were medical – mifepristone and misoprostol (after 9 weeks may need multiple doses of misoprostol
Mifepristone
Competitive, reversible progesterone receptor blocker
this increases production and sensitivity of the uterus to prostaglandins - 200mg oral
Misoprostol
a £1 tablet which can be oral or pessary – 800ug
After 9 weeks consider giving additional doses 4hrly up to max of 4 times
Side effects of termination
Pain – NSAIDs but paracetamol no better than placebo
Also – nausea, vomiting, diarrhoea, faintness, hot flushes, headaches, breast pain, rash, facial oedema, hypotension, infections
Complications of medical terminations
Early – bleeding for up to 9 days
Retained products or infection – if pregnancy does not terminate there can be teratogenic effects
Late – retained placenta (6-10%), uterine rupture (<3%)
Methods of surgical termination
Cervical priming – given in all cases, misoprostol 400ug 3hrs prior to surgery. can also use osmotic dilators
Can use manual (up to 7 wks) or electric vacuum aspiration (up to 14wks) or D & E (14 to 24wks)
Risk factors for uterine or cervical damage during a surgical termination
under 17yrs old Advanced gestational age
cervical abnormalities Previous surgery
Inexperienced surgeon
Complications of early surgical termination
Ongoing pregnancy (examine aspirate for gestational sac and follow up HCG) - 0.5%
Uterine (0.5%) or cervical trauma (<1%)
Retained products or infection
Complications of late surgical termination
uterine perforation or cervical laceration uterine atony pelvic abscess Ashermann's syndrome DVT or PE
Antibiotic prophylaxis for terminations
Metronidazole PO/PR + Azthromycin 1g PO/doxycycline 100mg BD for 7 days
If negative for chlamydia just metronidazole
Fetocide
If gestation is over 21wks and 6 days it is recommended that the fetal heart is stopped before termination - intracardiac KCL injection
Long term complications of terminations
Possibly an increased risk of miscarraige or preterm delivery in future pregnancies
Possible increase in psychiatric illness
Risk of death during a Termination
0.0003183% risk of dying based on 2006-2008 figures in UK
worldwide - 60-120,000 deaths per year
The Abortion act
first in 1967 and ammended in 1991 - five categories (A-E)
HSA1 form requires two doctors signatures
All terminations should be notified
Categories of legal reasons for terminating
A - Serious risk to mother’s life
B - Grave risk to mother’s physical or mental health
C - <24wks and risk to existing children of the mother
E - Serious risk the child would be born with a serious handicap
Arranging a termination
If living in, or have a GP in, south london you can self refer or be referred by the GP to the appropriate service 97% are NHS funded but 60% take place independent sector (Marie stopes or BPAS)
Arranging a termination for a child under 16 without parental consent
If they fulfill the Frasier competencies you can
But must seriously consider safeguarding issues
If under 13 then cannot consent and so should be considered an automatic child protection issue.
Termination and mental health
unwanted pregnancy is a risk factor for poor mental health but there is no difference between termination or having the baby
5-10% of women change their mind on the day, and 6-25% suffer some form of post abortion trauma
Attitude of partner is a major factor
