Termination of Pregnancy

Question 1

What is the definition of TOP?

Answer 1

The active termination of pregnancy before foetal viability which is 20 weeks or <500g

Question 2

What Act is TOP based on?

Answer 2

The choice on TOP Act 92 of 1996

Question 3

Which weeks is the 2nd trimester?

Answer 3

Between 13-28 weeks of gestation

Question 4

Under what conditions can a TOP occur after 12 weeks?

Answer 4

1. Upon request by any woman

Question 5

Under what conditions can a TOP occur between 13-20 weeks?

Answer 5

If the medical practitioner consults with the woman and:

1. Continued pregnancy poses a risk to the woman’s mental or physical health
2. Continued pregnancy poses a risk and the fetus would suffer from a mental or physical abnormality
3. The rape resulted from rape or incest
4. The continued pregnancy would significantly affect the woman’s socio-economic status

Question 6

Under what conditions can a TOP occur after 20 weeks gestational age?

Answer 6

After the medical practitioner consults with another doctor and they decide that:

1. The pregnancy would endanger the woman’s life
2. Would result is severe malformations of the fetus
3. Woul pose a risk of injury to the fetus

Question 7

What are the fetal indications for Termination of Pregnancy?

Answer 7

1. Congenital abnormalities-severe spina bifida, anencephaly
2. Chromosomal abnormalities-Trisomy 13,18,21
3. Intra-uterine death
4. Intra-uterine growth restriction
5. Rupture of membranes before 26 weeks
6. Prenatal infection-rubella, cytomegalovirus

Question 8

What are the conditions that would warrant TOP after 20 weeks?

Answer 8

1. Anencephaly
2. Trisomy 13,18
3. Renal agenesis
4. Hydrancephaly

Question 9

What are the maternal indications for TOP?

Answer 9

1. Severe early or complicated pre-eclampsi
2. Other medical conditions-pulmonary hypertension
3. Malignancy-cervical carcinoma
4. Chorio-amnionitis

Question 10

What are the advantages of using medical TOP?

Answer 10

1. It is more private
2. Higher success rate
3. Similar to natural miscarriage
4. Used in early pregnancy

Question 11

What are the disadvantages of using medical TOP?

Answer 11

1. Can last days to weeks
2. Requires two visits
3. Decreases in efficacy as the gestational age increases
4. Woman may see blood

Question 12

What are the advantages of using surgical TOP?

Answer 12

1. One visit required
2. High success rate
3. Completed within minutes

Question 13

What are the disadvantages of using surgical TOP?

Answer 13

1. Invasive procedure
2. Less private
3. Facilities not always available

Question 14

What is the medicine we use <9 weeks?

Answer 14

1. Methotrexate and misoprostol

Question 15

What is the medicine we use >12 weeks?

Answer 15

Prostaglandins or misoprostol

Question 16

How do we administer the misoprostol?

Answer 16

It can be taken orally, vaginally or rectally

The best is 600mcg vaginally every 6 hours for a maximum of 6 doses

Question 17

What are the medical options for TOP?

Answer 17

1. Misoprostol-first choice
2. Mifepristone(anti-progesterone)
3. Dinoprostone(very expensive, needs to be kept in fridge, needs high doses)
4. Oxytocin (poor effect on unfavorable cervix)

Question 18

How do surgically manage a patient TOP if they are between 12-16 weeks?

Answer 18

1. Dilation

2. Manual vacuum aspiration

Question 19

What syringe is used to aspirate?

Answer 19

The Karman syringe

Question 20

Who’s do we surgically manage these patients after 16 weeks?

Answer 20

1. Dilation and evacuation

Question 21

What are the complications associated with TOP?

Answer 21

1. Haemorrhage
2. Perforation specifically after previous uterine surgery
3. Uterine rupture-after previous c/s
4. Cervical trauma
5. Post-evacuation sepsis
6. Progression of pregnancy after unsuccessful induction

Question 22

At what age should patients be referred to a social worker?

Answer 22

<16 years