Termination of pregnancy

Question 1

What is the upper gestational limit for an abortion? What is the exception to this?

Answer 1

24 weeks

Exception: Down’s

Question 2

What document permits an abortion to be carried out? How many doctors need to sign this?

Answer 2

Abortion act certificate

2 registered medical practitioners

Question 3

Who has more rights in law when it comes to abortion: mother, foetus or partner?

Answer 3

Mother

Foetus has no rights
Partner has no rights

Question 4

What are some of the conditions on which an abortion can be allowed?

Answer 4

risk to life of pregnant woman if pregnancy continues

to prevent ‘grave permanent injury’ to physical or mental health of pregnant woman

Pregnancy has NOT EXCEEDED 24 th week

Risk of injury to physical or mental health of any existing children

Risk of severe developmental abnormalities

Question 5

What are doctors who conscientiously object to abortion allowed to abstain from?

Answer 5

Administering treatment

Signing abortion certificate

Question 6

What are doctors who conscientiously object to abortion NOT allowed to abstain from?

Answer 6

Giving advice
Facilitating referral
Preparatory steps for TOP

Question 7

What should you do if a woman comes to you and says she is pregnant and wants a termination?

Answer 7

Pregnancy test

Discuss options: continuation
termination
adoption
ALLOW TIME FOR DECISION - LEAFLETS, WEBSITES ETC.

Arrange US: viability, gestational age, no. of foetuses, exclude molar/ectopic

Follow up appointment

COUNSELLING

NON DIRECT and NON JUDGEMENTAL

Question 8

What are the medical options for a TOP?

Answer 8

Early medical abortion (EMA)

Late early medical abortion

mid trimester medical abortion

Question 9

What is the time limit for EMA?

Answer 9

<9 weeks

Question 10

What is the time limit for late early medical abortion?

Answer 10

9-12 weeks

Question 11

What is the time limit for mid-trimester medical abortion?

Answer 11

12-24 weeks

Question 12

What are surgical TOP options?

Answer 12

Manual vacuum aspiration (under conscious sedation) - 9-12 weeks

Surgical evacuation under GA 7-15 weeks

Dilatation/evacuation GA 15-18 weeks

Surgical vac without fetocide 19-22 weeks

surgical with fetocide 22-24 weeks

Question 13

Which form of TOP is most common? Why is this?

Answer 13

EMA

Natural experience/non-medicalised
Less traumatic
No surgery/GA

Question 14

What drugs are given in EMA?

Answer 14

Mifepristone (anti-progesterone) 200mg PO

36-38 hours later: misoprostol (prostaglandin) 800mcg PO/PV

Question 15

How is an EMA managed? Home or hospital? What support is in place?

Answer 15

Allowed home for second part

24 hours helpline

Follow up/telephone consultation in 4 weeks for PT

Question 16

When might MVA be used? What is it done under?

Answer 16

If contraindications to GA

Under 9 weeks pregnancy

Question 17

What sedation is an MVA done under?

Answer 17

No GA

Conscious sedation +/i sedation

Question 18

Why shouldn’t you STOP <7 weeks?

Answer 18

Risk of failure - incomplete or failed TOP

Question 19

What can be done to reduce risk of cervical trauma in STOP?

Answer 19

cervical prep

Question 20

When do the risks of complication increase in STOP?

Answer 20

with increasing gestation

Question 21

What are some of t he complications of a STOP?

Answer 21

Haemorrhage
Sepsis
PID
Uterine perforation

Hysterectomy
Death

Question 22

How long after a TOP can you use an IUD/IUS?

Answer 22

At time of STOP

Question 23

How long after a TOP can you use a COCP/POP?

Answer 23

Same day

Question 24

How long after a TOP can you use an Evra patch?

Answer 24

Same day

Question 25

How long after a TOP can you use a Nuva ring?

Answer 25

same day

Question 26

How long after a TOP can you use a DMPA?

Answer 26

Time of TOP

Question 27

How long after a TOP can you use a Nexplanon?

Answer 27

same day

Question 28

How long after a TOP can you sterilise someone?

Answer 28

interval procedure