Termination of Pregnancy

Question 1

What legislation is responsible for the reasons for termination of pregnancy in the UK?

Answer 1

The Abortion Act 1967 (amended 2002) and HFEA 1990

Question 2

What does The Abortion Act 1967 state as the reasons for termination of pregnancy?

Answer 2

A. Risk to mother’s life if pregnancy continues
B. Termination necessary to prevent permanent grave injury to physical/mental health of the mother
C. Continuing risks injury to physical/mental health of mother, greater than that of termination (AND foetus is not >24/40) - MOST COMMON
D. Continuing risks injury to physical/mental of existing children of the woman greater than that of termination (AND foetus is not >24/40)
E. There is substantial risk that if the child is born he/she would suffer such abnormalities as to be seriously handicapped.

Question 3

What are the requirements for a termination of pregnancy to be legal?

Answer 3

1. Must fulfil one of the reasons for TOP laid out by The Abortion Act 1967
2. 2 doctors must sign and agree
3. TOPs after 24 weeks may only be carried out in NHS hospitals.

Question 4

What investigations and management must be carried out before a termination of pregnancy?

Answer 4

1. Counselling and support
2. USS to confirm gestation
3. Screen for STIs/HIV
4. Antibiotics prophylaxis - metronidazole 1g at TOP and Azithromycin 1g PO same day
5. Discuss contraception
6. If Rh-D -ve, anti-D must be given

Question 5

What is the medical method of termination of pregnancy?

Answer 5

1. <7weeks and for 2nd trimester
2. Mifepristone to prime cervix and misoprostol 36-48 hours later
3. From 22 weeks it is essential that the foetus is born dead, feticide performed (KCl into umbilical vein/foetal heart), confirm asystole with USS.
4. If born after 24 weeks, stillbirth, needs registering.
5. For early TOPs, USS 2 weeks later to confirm completion.
6. NSAID/opioid pain relief

Question 6

What is the surgical method of termination of pregnancy?

Answer 6

1. Vacuum aspiration (7-14 weeks) under local or general anaesthetic
2. Or dilation and evacuation (13-24 weeks)
3. > 14 weeks, medical abortion usually favoured
4. Preoperative cervical preparation with misoprostol
5. NSAID during TOP
6. Less bleeding and pain than with medical management

Question 7

What are the complications of termination of pregnancy?

Answer 7

1. Haemorrhage
2. Infection
3. Uterine perforation
4. Cervical trauma
5. Failed TOP/retained produced of conception

Question 8

What are the steps that you need to take after a termination of pregnancy for the parents?

Answer 8

1. Leaflet explaining likely symptoms
2. 24 hour phone line
3. Refer to emotional support if mental health at risk
4. Pregnancy tests can stay positive for up to 4 weeks