Termination Of Pregancy Flashcards
In general, the earlier abortion is performed the ….. it is
Safer
Is major complication and mortality common or rare?
Rare if best practice is followed
If abortion is done in line with safe practice, is it safer than childbirth?
Yes
What is abortion?
The removal of expulsion of an embryo or foetus from the uterus before viability
What is spontaneous abortion called?
Miscarriage
Every year how many unsafe abortions occur?
22 million, leading to 47000 deaths
5 million left with chronic disability due to complications of unsafe abortion
Are abortion rates going up or down?
Down
What percentage are medically induced?
70%
What fraction are carried out less than or equal to 12 w gestation?
9/10
What guides abortion laws and regulations in the UK?
Abortion Act 1967
Human Fertilisation and Embryology Authority
What criteria has to be meet under the Abortion Act, for termination to occur?
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
What medication is used in a medical abortion?
Mifepristone = an anti progesterone
And a prostaglandin such as misoprostol
With or without fetocide (KCl) - after 21 weeks
How does mifepristone work?
An anti progesterone - it disrupts the hormonal lifeline to pregnancy
How does misoprostol work?
It induces uterine contractions
When is fetocide used?
Termination done after 21 weeks, usually if foetal abnormality diagnosed
Avoids situation where foetus is born alive after termination
What are the benefits of medical termination (compared to surgery)?
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
What disadvantages are associated with medical abortion?
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
What medical regime is used up to 63 days gestation (9 weeks)?
Mifepristone 200mg orally at hospital
24-48 hours later misoprostol 800micrograms (vaginally, buccal or sublingual) at home
What medical regime can be used from 64 days (9 weeks) to 13weeks and 6 days ?
Mifepristone 200mg orally at hospital
24-48 hours later misoprostol 800 micrograms at hospital
Followed by misoprostol 400micrograms every 3 hours until abortion occurs
Further on in pregnancy, is it harder or easier to induce abortion?
Harder
Can medical termination be done the same way after 14 gestation?
Yes but if after 24 hours abortion does not occur, mifepristone can be repeated 3 hours after last dose of misoprostol ie repeat process
What surgical procedures can be done?
Suction evacuation (first trimester) Dilation and evacuation (second)
What benefits are there for surgical abortion?
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
Below 14 weeks gestation, what surgical method can be done?
Manual or electrical vacuum aspiration (using a suction catheter)
Is there a lower limit of gestation for surgical abortion?
No but less than 7/40 risks of failure increase e.g missing the pregnancy
What should be considered before surgical abortion undertaken?
Cervical preparation to minimise trauma to cervix
Particularly if gestation over 10w and woman less than 18
What medication is used for cervical preparation?
Prostaglandins - misoprostol 400micrograms PV or PO 2-3 hours pre op
When could dilation and evacuation be done?
13-24 weeks after cervical priming
BUT rare, difficult to do and usually done at specialised centres
At UHL surgical termination is only performed up to…
12-14 weeks maximum
What complications of TOP are there?
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)
How many doctors must agree independently that the woman meets criteria for abortion?
2 e.g GP and doctor in abortion clinic
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