Termination of Pregnancy Flashcards
When should the decision to terminate a pregnancy preferably be made by?
24 weeks
Which 2 medications are given for TOP?
Mifepristone and Misoprostol
When should feticide be offered?
TOP >22/40
When should the baby be given assistance after birth?
- If woman declines feticide and baby is born alive but the anomaly is fatal, provide palliative care
- If women declines feticide and baby is born alive and condition is non-lethal, provide NN care
What administration needs to be done when a woman requests a TOP?
- Appointment for gynae clinic
- Cancel all scans and appointments
- Inform GP
- Close pregnancy on IT system
What is the process for a medical TOP?
- Give Mifepristone 200mg PO (stay for 2 hours then go home)
- Admit 48 hours later and take FBC and G+S
- Give misoprostol 800mcg PV
- Give 400mcg Misoprostol PO every 3 hours from the 1st dose, max. 4 doses
What happens if the woman doesn’t deliver within 24 hours?
- Consultant review to consider second course of Misoprostol
- Courses must be 12 hours apart
What is required for a post-mortem examination on the baby?
Parental consent
What are the risks associated with a medical TOP?
- Need for ERPC if unsuccessful
- Haemorrhage
- Uterine perforation
- Infection
What does ERPC stand for?
Evacuation of Retained Products of Conception
What should be done prior to an ERPC?
- Screening for infections (inc. Chlamydia)
- Misoprostol PV 1 hour prior
- FBC and G+S
What are the risks associated with a surgical TOP?
- Need for additional procedures
- Haemorrhage
- Uterine perforation
- Infection
- Cervical trauma
What additional procedures may be required if an ERPC is difficult?
- Laparotomy
- Second ERPC
- GA
What are the 3 options for disposal of foetal remains?
- Private arrangements
- Hospital burial
- Hospital cremation
How does a hospital burial work?
- Chaplain leads group service with other deceased babies
- Shared grave so not able to have headstone
- Can attend the service
