Termination of pregnancy

Question 1

Statutory grounds for TOP in England

Answer 1

A Continuance of pregnancy would involve risk to the life of the pregnant women greater than if the pregnancy were terminated
B Termination is necessary to prevent grave permanent injury to physical or mental health of pregnant woman
C Not exceeded 24th week and continuance of pregnancy would involve risk, greater than if the pregnancy was terminated of injury to physical or mental health of the woman
D Not exceeded 24th week and continuance of pregnancy would involve risk, greater than if the pregnancy was terminated of injury to physical or mental health of any existing children of the family of the woman
E There is a substantial risk that of the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped

Question 2

Management

Answer 2

Method depends on gestation and maternal preference
Bloods for Hb, blood group and rhesus status
Rh-ve women should receive anti-D within 72h of TOP
Contraception discussed
Chlamydia screening
Counselling

Question 3

Surgical methods

Answer 3

Suction curettage between 7 and 13 weeks
Dilatation and evacuation, preceded by cervical preparation after 13 weeks
Antibiotic cover

Question 4

Medical methods

Answer 4

Anti-progesterone mifepristone, plus prostaglandin 36-48h later
Most effective method <7 weeks and 13-24 weeks, can also be used 7-9weeks
Beyond 22 weeks, feticide is first performed to prevent live birth

Question 5

Complications

Answer 5

Haemorrhage
Infection
Uterine perforation
Cervical trauma
Failure
Multiple surgical abortions carry later risk of preterm delivery
Psychological sequelae