Termination of Pregnancy

Question 1

ABORTION ACT 1967

• Certificate A
• Form HSA2(Certificate B) for emergency abortions

Answer 1

• Signed by 2 medical practitioners
  A) risk to life
  B) Prevent grave permanent injury
  C) Prevent injury to physical/mental health of pregnant women <24w
  D) Prevent injury to physical/mental health of existing children <24w
  E) if child is at risk of serious handicap
• Form HSA2(Certificate B), to be competed by 1 medical practitioner within 24h of emergency abortion and kept for 3y
  F) To save life of pregnant woman
  G) To prevent grave permanent injury to physical/mental health of pregnant woman

Question 2

INVESTIGATIONS:

Answer 2

1. Pregnancy test
2. USS(usually cannot see gestational sac <6w)
3. FBC
   - to look for anaemia
4. Group and Save
   - for anti-D if needed
5. Chlamydia screen
   - Risk assessment and offer testing for toher STIs
   - offer condoms for STI prevention

Question 3

WHEN SHOULD WOMEN ASKING FOR TOP BE SEEN?

Answer 3

1. As soon as possible if requiring termination for urgent medical reasons.
2. Should be assessed within 2w of referral.
3. Should undergo abortion within 2w of decision to proceed, ideally within 7d.
4. No woman should wait >3w from initial referral to time of abortion.

Question 4

MEDICAL TERMINATIONS:
*New guidelines say at any gestation now

Efficacy: 94.5%

Answer 4

1. Mifepristone(200 mg)
   - Destabilize pregnancy
2. Vaginal misoprostol 800 mcg/Gemeprost 1mg
   - Expel pregnancy
   - For 2nd trimester, in addition to inital dose of misoprostol, give every 3h until a maximum of 4 doses
   - Antibiotic prophylaxis offered against Chlamydia and anaerobes.

Question 5

MEDICAL TERMINATION CONTRAINDICATIONS:

Answer 5

1. Absolute: Suspected ectopic pregnancy, *possibly active asthma, patient on long term corticosteroid, haemolytic disease, on anticoagulants
2. Caution in: Liver/renal disease, smoker, peripheral vascular disease, coronary artery disease

Question 6

MEDICAL TERMINATION COMPLICATIONS:

Answer 6

1. Uterine rupture 1 in 1000 at late gestations.
2. Severe bleeding requiring transfusion <1 in 1000, rises to around 4 in 1000 if >20w
3. Risk of further intervention ie surgical for incomplete abortion <5%

Question 7

SURGICAL TERMINATION COMPLICATIONS:

Answer 7

1. Uterine perforation 1-4 in 1000. lower in early gestations and experience surgeon.
2. Cervical trauma <1 in 100. Lower for early abortions and experienced surgeon.
3. May require further treatment ie blood transfusion, laparoscopy or laparotomy
4. Infection <1 in 100
5. Risks from general anaesthetic

Question 8

SURGICAL TERMINATION:

Answer 8

• Between 7-12w
• Cervical priming with 400 mcg Misoprostol 3h prior to surgery to decrease complications.
• Vacuum aspiration
• Anti-D within 72h if Rh-ve.
• Antibiotic prophylaxis offered against Chlamydia and anaerobes.