Termination of pregnancy

Question 1

What are the different grounds A-G of termination of pregnancy?

Answer 1

A - continuance of pregnancy = involves risk of life to pregnant woman greater than if preg. was terminated

B - Termination necessary to prevent grave permanent injury to physical/mental health of woman

C - pregnancy has not exceeded week 24 + continuance of pregnancy would involve risk, greater than if terminated, of injury to physical/mental health of pregnant woman = ‘social’ = most common

D - pregnancy has not reached 24weeks and continuance would involve risk, greater than if terminated, of injury to physical/mental health of existing children of woman

E - substantial risk that if child is born it would suffer from physical/mental abnormalities as to be seriously handicapped = fetal/chromosomal abnormalities = 2nd most common

F - it was necessary to save life of woman

G - necessary to prevent grave permanent injury to physical/mental health of woman

Question 2

Describe what happens in the initial TOP consultation

Answer 2

a 1 hour appointment

• certainty to proceed/discuss alternatives
• complete medical history
• discuss suitable methods
• bloods: FBC/G+S/rubella +/- BBV
• optional STI screen
• USS to determine gestation and confirm pregnancy in-utero
• written consent for treatment
• discussion contraceptives

Question 3

What different types of termination of pregnancy exist?

Answer 3

• Early: 9weeks or earlier
• Late: 9-12 weeks
• mid trimester: 12-24 weeks

Question 4

Describe the medical process of termination of pregnancy? how is this done in the early/late/mid-trim times?

Answer 4

2 stages:

• oral mifepristone 200mg (antiprogesterone - induces uterine contractions and increases prostaglandin sensitivity)
• 24-48 hours later vaginal (or oral) prostaglandin e.g. misoprostol/gemeprost (soften neck of womb and opens cervix)

Early:

• option to complete 2nd half at home
• late/mid trimester = repeated dose prostaglandin every 3 hours (max 5/24hours)

Failure of this may require surgical intervention

Question 5

Describe the surgical methods of termination of pregnancy? at what gestation is which done?

Answer 5

2 methods under GA, cervical priming with vaginal PG

Vacuum aspiration - 6-13 weeks
Dilatation and evacuation - 13-24weeks (not avail in scot.)

Daycase, routine USS not required, LARC fitting

Question 6

What is manual method for TOP? what can this also be used for?

Answer 6

newer alternative for earlier gestation: TOP - also for retained productes of conception after miscarriage

• can be performed under local anaesthetic
• role in resource-poor settings

Question 7

What are the procedural risks of TOP?

Answer 7

• pain
• bleeding
• infection
• failure of medical
• uterine perforation
• cervical trauma

Question 8

what is the follow up for TOP?

Answer 8

Usually a urine pregnancy test at 2-3 weeks

-LARC at time, prior to discharge