Termination of pregnancy Flashcards
Termination of pregnancy - law (2008)
- Registered medical practitioner may perform an abortion on a woman who is not more than 24 weeks pregnant
- A registered medical practitioner may perform an abortion on a woman who is more than 24 weeks pregnant only if the medical practitioner:
i. Reasonably believes the abortion to be appropriate in all circumstances (including the woman’s current and future physical, psychological and social circumstances)
ii. Has consulted at least one other registered medical practitioner who also reasonably believes that the abortion is appropriate in all the circumstances
Surgical termination of pregnancy - overview of (3)
- Performed under general anaesthetic, or local anaesthetic with sedation
- First trimester terminations = usually performed as day procedure with suction curettage
- Second trimester terminations = dilation and evacuation
Suction curettage - method
For first trimester termination
- Performed under general anaesthetic, or local anaesthetic with sedation, day procedure (95% performed under light IV sedation)
- Dilate cervix with series of graduated blunt-ended dilators in increments of 1mm, usually to dilation of about 6-8mm. Cervix usually needs to be dilated to the same number of weeks of pregnancy
- Contents of uterus evacuated by suction through a small plastic tube inserted through the uterus
- Second instrument (curette) can be used to reach the upper outside areas of the uterus (corneal areas) to ensure that the uterus is completely empty
- In pregnancies of 12 weeks or more, a cervical softening agent may be used to aid dilation of the cervix
Suction curettage - complications
- Uterine perforation
- Cervical trauma
- Bleeding, haemorrhage
- Symptomatic infection
- Retained products of conception
+ anaesthesia risks
Suction curettage - failure rate
0.2% risk of continuing pregnancy
Dilatation and evacuation - method
- Cervical priming prior to dilatation (e.g. osmotic dilators or pharmacological agents - e.g. misoprostol)
- Local or general anaesthesia used
- Cervix may be dilated manually (using dilators)
- Products of conception are removed (usually piecemeal) using forceps. Sometimes the fetus will be passed intact if sufficient cervical dilatation has occurred
- Oxytocic agents may be given (to stimulate the uterus to contract and to reduce immediate blood loss), but no RCOG/WHO recommendation (?)
Dilatation and evacuation - failure rate
D&E will always terminate a pregnancy, unless factors such as anatomical abnormality or anaesthetic complications prevent the procedure from being completed
Dilatation and evacuation - complications
Similar to those described for suction curettage
- Uterine perforation
- Cervical trauma
- Bleeding, haemorrhage
- Symptomatic infection
- Retained products of conception
+ anaesthesia risks
Surgical TOP - side effects (3)
- Pain (oral analgesia usually adequate, prophylactic analgesia not indicated)
- Bleeding to be expected (mean bleeding time 5-10d); serious blood loss or haemorrhage is rare
- Nausea/vomiting from possible vasovagal/parasympathetic stimulation
Medical TOP - overview
- Generally performed at gestations
Medical TOP - side effects
- Pain (to be expected; cramping in 90%, can be managed with oral analgesia for most women)
- Bleeding (to be expected; mean time 9-15d)
- Vomiting, nausea
- Dizziness, headache
- Chills, shivering and fever
Side effects found to be acceptable by most women
Medical TOP - failure rate
5% (will require surgical evacuation of uterus for incomplete abortion or continuing pregnancy)
Medical TOP - complications
- Haemorrhage requiring blood transfusion
- Pelvic or genital tract infection
- If unsuccessful, may need to be followed up with surgical TOP
- Mortality has been reported, but rare - toxic shock syndrome associated with clostridium sordelli
- Small number of reports of congenital defects in infants of women who have taken misoprostol in the first trimester in an unsuccessful attempt to induce abortion and proceeded to birth - Mobius’ syndrome (facial paralysis), limb defects
