Termination

Question 1

How many terminations were there in 2012?

Answer 1

185,122 residents, 5,850 non-residents - mostly irish = 190,972
97% NHS funded
Highest rates are in southwark, lambeth and lewisham

Question 2

When do terminations happen?

Answer 2

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

Question 3

Terminations due to fetal abnormality

Answer 3

2,692 in 2012 –> 38% were chromosomal abnormalities

Question 4

Methods of termination

Answer 4

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

Question 5

Mifepristone

Answer 5

Competitive, reversible progesterone receptor blocker

this increases production and sensitivity of the uterus to prostaglandins - 200mg oral

Question 6

Misoprostol

Answer 6

a £1 tablet which can be oral or pessary – 800ug

After 9 weeks consider giving additional doses 4hrly up to max of 4 times

Question 7

Side effects of termination

Answer 7

Pain – NSAIDs but paracetamol no better than placebo
Also – nausea, vomiting, diarrhoea, faintness, hot flushes, headaches, breast pain, rash, facial oedema, hypotension, infections

Question 8

Complications of medical terminations

Answer 8

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%)

Question 9

Methods of surgical termination

Answer 9

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)

Question 10

Risk factors for uterine or cervical damage during a surgical termination

Answer 10

under 17yrs old Advanced gestational age
cervical abnormalities Previous surgery
Inexperienced surgeon

Question 11

Complications of early surgical termination

Answer 11

Ongoing pregnancy (examine aspirate for gestational sac and follow up HCG) - 0.5%
Uterine (0.5%) or cervical trauma (<1%)
Retained products or infection

Question 12

Complications of late surgical termination

Answer 12

uterine perforation or cervical laceration
uterine atony
pelvic abscess
Ashermann's syndrome
DVT or PE

Question 13

Antibiotic prophylaxis for terminations

Answer 13

Metronidazole PO/PR + Azthromycin 1g PO/doxycycline 100mg BD for 7 days
If negative for chlamydia just metronidazole

Question 14

Fetocide

Answer 14

If gestation is over 21wks and 6 days it is recommended that the fetal heart is stopped before termination - intracardiac KCL injection

Question 15

Long term complications of terminations

Answer 15

Possibly an increased risk of miscarraige or preterm delivery in future pregnancies
Possible increase in psychiatric illness

Question 16

Risk of death during a Termination

Answer 16

0.0003183% risk of dying based on 2006-2008 figures in UK

worldwide - 60-120,000 deaths per year

Question 17

The Abortion act

Answer 17

first in 1967 and ammended in 1991 - five categories (A-E)
HSA1 form requires two doctors signatures
All terminations should be notified

Question 18

Categories of legal reasons for terminating

Answer 18

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

Question 19

Arranging a termination

Answer 19

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)

Question 20

Arranging a termination for a child under 16 without parental consent

Answer 20

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.

Question 21

Termination and mental health

Answer 21

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