Termination Of Pregnancy

Question 0

Indications for TOP

Answer 0

First twelve weeks
Thirteenth week to twentieth. If pregnancy is a risk to woman’s physical or mental health. OR fetus may suffer from physical or mental abnormality. OR rape is of incest or rape OR if pregnancy will significantly affect SES.
After twentieth week- if pregnancy would endanger woman’s life OR result in severe fetal malformation OR pose risk of injury to fetus.

Question 1

Methods of TOP

Answer 1

1. Vacuum curettage
2. Medical abortion- mifepristone and misoprostol, methotrexate and misoprostol, misoprostol only.
3. Dilatation and evacuation (D&E)
4. Induction of labour- mifepristone and misoprostol or misoprostol.
5. Hysterectomy
6. Hysterotomy- similar to Caesarian but with a smaller incision.

Question 2

How does medical abortion work

Answer 2

Medical abortion can only be performed until 9 weeks. Most effective before 7 weeks. Drugs used to terminate a pregnancy antagonize or inhibit the action of progesterone by causing decidual necrosis and detachment of the pregnancy, and/or stimulate myometrial contractions.
Stage 1- mifepristone administered
Stage 2- 24-48 hrs later. Self administration of misoprostol vaginally. Patient experiences vaginal bleeding, clots, cramps.

Question 3

What are the complications of medical TOP.

Answer 3

Heavy vaginal bleeding
Incomplete abortion
Endometritis
Failed Medical TOP

Question 4

What are the abortion options in the second trimester

Answer 4

Dilatation and evacuation
Labour induction with misoprostol or mifepristone and misoprostol. Then evacuation of retained products of conception (ERPOC) is done using vacuum curettage/suction (surgical abortion)