Termination of Pregnancy

Question 1

Managing unplanned pregnancy

Answer 1

Early diagnosis of pregnancy is ideal
Counselling- non directive and non-judgemental, enable woman to voice doubts and concerns
Explore options and provide

Question 2

Abortion care- methods available in weeks (Early medical abortion )

Answer 2

Early medical abortion (MTOP) = 9 weeks +6 days
Uses mifepristone and PG- appropriate method at any gestation under 9 weeks
Mifepristone acts to detach the villi from the placenta
At 9-12 weeks, the villi infiltrate the muscle, so much harder to detach and therefore higher failure rate
Mifepristone 200mg PO, then 24-36 hours later misoprostol 800mcg PV
Misoprostol causes contractions
Reasons for this method:
Seemed a more ‘natural’ experience
No surgery or anaesthesia needed
Afforded more privacy
Perceived to be less frightening and easier emotionally than a surgical abortion
Required a shorter stay in hospital
Easier, simpler and faster

Question 3

Manual Vacuum aspiration

Answer 3

(MVA) = 9 weeks +6 days

Question 4

Suction termination (STOP) = up to 14

Answer 4

Cervical preparation is beneficial prior to suction termination
Suction termination may be safer under local anaesthesia than general- MVA

Suction termination of pregnancy should be avoided
at gestations of < 7 weeks. No longer the case.at gestations of < 7 weeks. No longer the case.
** Conventional suction termination is an appropriate Conventional suction termination is an appropriate
method at gestations of upto 14 weeksmethod at gestations of upto 14 weeks
** Cervical preparation is beneficial prior to suction Cervical preparation is beneficial prior to suction
termination termination
** Suction termination may be safer under local Suction termination may be safer under local
anaesthesia than general – Manual Vacuum anaesthesia than general – Manual Vacuum
Aspiration (MVA)

Question 5

Dilatation and evacuation

Answer 5

15-18

Question 6

Mid-trimester medical abortion

Answer 6

14-24

Question 7

Two stage surgical procedure

Answer 7

19-24

Question 8

Induced abortion: Complications during the procedure

Answer 8

Immediate: anaesthetic, uterine perforation, cervical tears, primary haemorrhage, uterine rupture (from caesarean scar), death

After discharge complications are rare: retained products of conception, secondary haemorrhage, pelvic infection, failed abortion, ectopic pregnancy

Late: tubal factor infertility, screening and antibiotics (prevention), Rhesus Iso-immunisation (blood group and anti-D administration), psychological and psychosexual sequelae, counselling support and options to patients

Question 9

Abortion care: prevention of STI

Answer 9

Screen all women - opt out policy:
Chlamydia
Gonorrhoea
Syphilis
HIV

Treat positives and contact tracing to screen Treat positives and contact tracing to screen
and treat partners if they too are infectedand treat partners if they too are infected
This will help with impact on their health and This will help with impact on their health and
future fertility

Question 10

Aftercare

Answer 10

Anti-D prophylaxis, written info, contact numbers for support, counselling services, STI service follow up, contraception advice and provision, follow up appointment within 2 weeks optional