Termination Of Pregancy

Question 1

In general, the earlier abortion is performed the ….. it is

Answer 1

Safer

Question 2

Is major complication and mortality common or rare?

Answer 2

Rare if best practice is followed

Question 3

If abortion is done in line with safe practice, is it safer than childbirth?

Answer 3

Yes

Question 4

What is abortion?

Answer 4

The removal of expulsion of an embryo or foetus from the uterus before viability

Question 5

What is spontaneous abortion called?

Answer 5

Miscarriage

Question 6

Every year how many unsafe abortions occur?

Answer 6

22 million, leading to 47000 deaths

5 million left with chronic disability due to complications of unsafe abortion

Question 7

Are abortion rates going up or down?

Answer 7

Down

Question 8

What percentage are medically induced?

Answer 8

70%

Question 9

What fraction are carried out less than or equal to 12 w gestation?

Answer 9

9/10

Question 10

What guides abortion laws and regulations in the UK?

Answer 10

Abortion Act 1967

Human Fertilisation and Embryology Authority

Question 11

What criteria has to be meet under the Abortion Act, for termination to occur?

Answer 11

Any of:
A) the pregnancy has not exceeded its 24th week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family; OR
B) the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman; OR
C) the continuance of the pregnancy would involve risk to the life of the pregnant woman, greater than if the pregnancy were terminated; OR
D) there is substantial risk that the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped

Question 12

What medication is used in a medical abortion?

Answer 12

Mifepristone = an anti progesterone
And a prostaglandin such as misoprostol
With or without fetocide (KCl) - after 21 weeks

Question 12

How does mifepristone work?

Answer 12

An anti progesterone - it disrupts the hormonal lifeline to pregnancy

Question 13

How does misoprostol work?

Answer 13

It induces uterine contractions

Question 14

When is fetocide used?

Answer 14

Termination done after 21 weeks, usually if foetal abnormality diagnosed
Avoids situation where foetus is born alive after termination

Question 15

What are the benefits of medical termination (compared to surgery)?

Answer 15

Avoid surgery
Can take place at home - the prostaglandin part (if less than 9 weeks)
Mimics miscarriage

May be necessary if severely obese, need to avoid surgery, uterine malformations

Question 16

What disadvantages are associated with medical abortion?

Answer 16

Takes time - hours to days to complete 
May not be predictable 
Experience bleeding, cramping
SEs e.g nausea and vomiting 
May require further visit to check all tissue expelled

Question 17

What medical regime is used up to 63 days gestation (9 weeks)?

Answer 17

Mifepristone 200mg orally at hospital

24-48 hours later misoprostol 800micrograms (vaginally, buccal or sublingual) at home

Question 18

What medical regime can be used from 64 days (9 weeks) to 13weeks and 6 days ?

Answer 18

Mifepristone 200mg orally at hospital
24-48 hours later misoprostol 800 micrograms at hospital
Followed by misoprostol 400micrograms every 3 hours until abortion occurs

Question 19

Further on in pregnancy, is it harder or easier to induce abortion?

Answer 19

Harder

Question 20

Can medical termination be done the same way after 14 gestation?

Answer 20

Yes but if after 24 hours abortion does not occur, mifepristone can be repeated 3 hours after last dose of misoprostol ie repeat process

Question 21

What surgical procedures can be done?

Answer 21

Suction evacuation (first trimester)
Dilation and evacuation (second)

Question 22

What benefits are there for surgical abortion?

Answer 22

Quick
Complete abortion and easily verified
Sterilisation or placement of IUD may be performed at same time

May be necessary if contraindications for medication or if constraints for timing

Question 23

Below 14 weeks gestation, what surgical method can be done?

Answer 23

Manual or electrical vacuum aspiration (using a suction catheter)

Question 24

Is there a lower limit of gestation for surgical abortion?

Answer 24

No but less than 7/40 risks of failure increase e.g missing the pregnancy

Question 25

What should be considered before surgical abortion undertaken?

Answer 25

Cervical preparation to minimise trauma to cervix

Particularly if gestation over 10w and woman less than 18

Question 26

What medication is used for cervical preparation?

Answer 26

Prostaglandins - misoprostol 400micrograms PV or PO 2-3 hours pre op

Question 27

When could dilation and evacuation be done?

Answer 27

13-24 weeks after cervical priming

BUT rare, difficult to do and usually done at specialised centres

Question 28

At UHL surgical termination is only performed up to…

Answer 28

12-14 weeks maximum

Question 29

What complications of TOP are there?

Answer 29

Surgical and medical methods carry a small risk of failure to end pregnancy
Need for further intervention to complete procedure e.g surgical after medical or re-evacuation (<2% for surgical and <5% for medical)
Haemorrhage requiring transfusion (early terminations have very low risk)
Uterine rupture in second trimester medical termination
Surgical - cervical trauma, uterine perforation
Upper genital tract infection with surgical or medical abortion unlikely but may occur and is usually associated with pre existing infection
Further treatment may be required e.g transfusion, laparoscopy, laparotomy, hysterectomy (but rate low)

Question 30

How many doctors must agree independently that the woman meets criteria for abortion?

Answer 30

2 e.g GP and doctor in abortion clinic

Blue form