Termination of Pregnancy

Question 1

Define what a termination of pregnancy/abortion is.

Answer 1

Deliberate act to bring about the demise and loss of ongoing pregnancy

Question 2

What is the policy regarding abortion in Victoria? When do abortions usually occur during pregnancy and what are the reasons which they occur in the 2nd trimester?

Answer 2

Abortion at any stage of pregnancy is legal in Victoria. 90% of abortions occur in the first 12 weeks of gestation. It occurs in the 2nd trimester only when there are fetal abnormalities, delay in the diagnosis of the pregnancy or other psychosocial issues. Note that the risk of complications in a termination of pregnancy increases after 14 weeks.

Question 3

Discuss the Medical option in regards to the Termination of Pregnancy.

Answer 3

Medical Termination of Pregnancy (MTOP) involves two different medications: misoprostol and mifepristone. Mifepristone is a progestational which primes the uterus and the cervix for the actions of the prostaglandins. Misoprostol is a prostaglandin analogue which is given sublingually, buccal or vaginally. It is given 36-48 hours after mifepristone. Following the dose of misoprostol, the abortion will be complete in 8 hours following.

Question 4

What are the 3 ways in which you confirm the completion of the medical termination of pregnancy?

Answer 4

1. Witnessing the products of conception
2. Follow-up beta-hCG
3. Pelvic Ultrasound

Question 5

Discuss the Surgical Termination of Pregnancy (STOP).

Answer 5

First the misoprostol is used to soften the uterine cervix as it decreases blood loss and perforation. 1-3 hours following this, the cervix is dilated 6 to 10 mm. Finally, suction curettage is performed using a plastic catheter. Using this method, there is a decrease in perforation injuries and rates of post-STOP Ashermann’s Syndrome which is adhesions/fibrosis of the endometrium which can follow a D&C of the intrauterine cavity.

Question 6

Discuss 2nd Trimester Termination of Pregnancies in terms of medical and surgical management.

Answer 6

MTOP is more common after 14 weeks but both MTOP and STOP are associated with higher rates of bleeding and blood transfusions. Simiarl MTOP in 2nd trimester but might need up to 5 doses of misoprostol rather than just the 1 in 1st trimester. The average length to delivery is 12 hours but that varies based on gestation. In terms of STOP, dilation and evacuation with the cervix needing to be dilated up to 18mm which takes up to 24 hours following the misoprostol.

Question 7

What are other complications associated with Termination of Pregnancy?

Answer 7

• Endometriosis – fever, temperatre with or without discharge
• Retained products of conceptus
• Damage to uterus – perforations
• Infertility – with ascending pelvic infections
• Ashermann’s Syndrome – results in amenorrhoea + later lack of conception
• Psychological aspects