Termination of pregnancy

Question 1

What sort of imaging would you do in someone you think is pregnant and is under 12 weeks gestation to confirm they are pregnant?

Answer 1

Transvaginal USS

Question 2

What STIs would you check for when investigating someone who is intending to terminate a pregnancy?

Answer 2

• Chlamydia
• Gonorrhoea
• HIV
• Hepatitis

Question 3

When would surgical management of termination of pregnancy be used (in terms of gestation)?

Answer 3

5-12 weeks

Question 4

Based on the abortion act (1967) and Human fertilisation and Embryology act (1990), when is termination of a pregnancy allowed?

Answer 4

1. Risk to the mothers life
2. Termination necessary to prevent permanent grave injury to physical/mental health of the woman
3. Continuation risks injury to mental/physical health of the woman greater than termination
4. Continuance risks injury to physical/mental health of existing children of the woman greater than if terminated
5. Substantial risk that if child were born he/she would suffer such physcial/mental abnormalities as to be seriously handicapped

So basically.. continuation of pregnancy would cause greater harm to badby and mother than termination of the pregnancy

Question 5

How many doctors have to signs an HSA1 form?

Answer 5

2 doctors

Question 6

What would you want to discuss with a woman who is looking to terminate a pregnancy (i.e. in the history)?

Answer 6

• Confirm she is pregnant - ask about LMP, pregnancy tests, symptoms of pregnancy, contraception, sexual partners, circumstances of pregnancy
• Ask about social circumstances - partner, support, coersion, job etc.
• Ask about symptoms of STIs - chlamydia, gonorrhoea etc.
• Ask obstetric history - previous pregnancy/abortion, parity, gravidity etc.
• Other relevant history - PMH, drugs, FH etc.

Question 7

What is involved in medical termination of pregnancy (MTOP)?

Answer 7

Medical management

• Mifepristone - prime the cervix (anti-oestrogen - switches off pregnancy homrone which is keeping uterus from contracting and allowing pregnancy to grow)
• Misoprostol - Prostaglandin (initiates uterine contraction which opens cervix and expels pregnancy)

2 week follow up to confirm it is complete

Up to 24 weeks from pregnancy (most done under 12)

Can be carried out at home if <9 weeks

Question 8

What proportion of individuals will need surgical evacuation following medical termination of pregnancy?

Answer 8

5%

Question 9

What are complcations of termination of pregnancy?

Answer 9

• Failure < 5 in 100
• Haemorrhage < 5 in 100
• Infection (screen)
• Prolonged bleeding (< 5 in 100)

Question 10

How does mifepristone work?

Answer 10

Switches pregnancy hormone which is keeping uterus from contracting and allowing pregnancy to grow. It also primes the cervix

Question 11

How soon after mifepristone would you give misoprostol?

Answer 11

48 hours after

Question 12

What are options for surgical termination of pregnancy?

Answer 12

Consider pre-operative cervical preparation

• Vacuum aspiration - Used from 7-14 weeks
• Dilation and curettage - 13-24 weeks

Question 13

What is involved in dilatation and curettage?

Answer 13

Dilation and curettage (D&C) refers to the dilation (widening) of the cervix and surgical removal of part of the lining of the uterus and/or contents of the uterus by scraping and scooping (curettage).

Question 14

What is important to start following termination of pregnancy?

Answer 14

• Consider anti-D
• Contraception
• Psychological support

Question 15

What is feticide?

Answer 15

Termination after 21 weeks and 6 days

Question 16

What is the process used for foeticide?

Answer 16

If not monochorionic twins**

Injection of 3 mL intracardiac 15% potassium chloride (+/- anaesthetic and/or muscle relaxant intillation beforehand to abolish foetal movement) Asystole is confirmed with ultrasound

If monochorionic

Diathermy of the cord