Termination of pregnancy

Question 1

What are the five grounds for termination of pregnancy?

Answer 1

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

Question 2

What is the time limit of clause A, B, and E of the Abortion Act of 1967?

A: continuance of the pregnancy would involve risk to life of pregnant woman greater than if
pregnancy were terminated.
B: termination is necessary to prevent grave permanent injury to physical or mental health of
pregnant woman.
E: there is a substantial risk that if the child were born it would su er from such physical or
mental abnormalities as to be seriously handicapped.

Answer 2

no time limit.

Question 3

What is the time limit of clause C and D of the Abortion Act of 1967?

Answer 3

24 weeks

Question 4

What does the GMC say about a doctor’s obligation (or lack thereof) to participate in terminations of pregnancy?

Answer 4

According to the GMC:
* Doctors must ensure their personal beliefs do not prejudice patient care.
* Doctors have the right to decline to participate in TOPs on grounds of conscientious objection. If
so, they must always refer the patient to another doctor who will help.

Question 5

For patients who are 16 years old, what should be advised if they are seeking a termination of pregnancy?

Answer 5

Patients <16yrs should be encouraged to involve their parents, but provided they are considered to be
Fraser competent, they can give their own consent.

Question 6

What are the two methods of termination of pregnancy?

Answer 6

• surgical
• medical

Question 7

nWhat medicatioms are used to terminate a pregnancy?

Answer 7

mifepristone and misoprostol

Question 8

What type of medication is mifepristone?

Answer 8

antiprogesterone

It results in:
* uterine contractions
* bleeding from the placental bed
* sensitization of uterus to PGs.

Question 9

What type pf medication is misoprostol?

Answer 9

prostaglandin 1 analogue

It stimulates uterine contractions.

Question 10

What risks and complications are associated with a termination of pregnancy?

Answer 10

• Significant bleeding needing transfusion (1–4:1000).
• Genital tract infection (5–10%).
• Uterine perforation (surgical TOP: 1–4:1000).
• Uterine rupture (mid-trimester medical TOP – <1:1000).
• Cervical trauma (surgical TOP: 1:100).
• Failed TOP (surgical: 2.3:1000; medical: 1–14:1000).
• Retained products of conception (1:100).
• Nausea, vomiting, diarrhoea due to PGs:
• occasional, but transient.
• Psychological sequelae:
• short-term anxiety and depressed mood.
• Long-term regret and concern about future fertility has been shown to be common.

Question 11

What medications are used to prophylactically prevent infection after a termination of pregnancy?

Answer 11

metronidazole 1g PR on day of TOP, and doxycycline 100mg PO for 7 days

commencing on day of TOP.

Question 12

When should women be followed up after a termination of pregnancy?

Answer 12

follow-up should be performed within 2 weeks