Termination of pregnancy (abortion)

Question 1

Management in TOP for pregnant women <14 weeks vs >14 weeks:

Answer 1

Cervical dilatation and suction of the contents of the uterus (usually up to 14 weeks)

Cervical dilatation and evacuation using forceps (between 14 and 24 weeks)

Question 2

vaginal misoprostol uses in pregnancy:

Answer 2

1. in conjunction with mifepristone for medical TOP (misoprostol used 1-2 days after mifepristone, (anti-progestogen))
2. monotherapy in medical management of miscarriage or induction of labour

Question 3

what is misoprostol?

Answer 3

anti-progestogen medication that blocks the action of progesterone, halting the pregnancy and relaxing the cervix.

Question 4

what medications are used for cervical priming before a surgical abortion?

Answer 4

g. This involves softening and dilating the cervix with misoprostol, mifepristone or osmotic dilators. Osmotic dilators are devices inserted into the cervix, that gradually expand as they absorb fluid, opening the cervical canal.

Question 5

at what gestation should anti-D prophylaxis be given for surgical TOP?

Answer 5

The NICE guidelines (2019) say it should be considered in women less than 10 weeks gestation.

Question 6

post-abortion care

Answer 6

Women may experience vaginal bleeding and abdominal cramps intermittently for up to 2 weeks after the procedure.

A urine pregnancy test is performed 3 weeks after the abortion to confirm it is complete.

Contraception is discussed and started where appropriate.

Support and counselling is offered.

Question 7

complications of abortion

Answer 7

Bleeding
Pain
Infection
Failure of the abortion (pregnancy continues)
Damage to the cervix, uterus or other structures

Question 8

what charity provides abortion services

Answer 8

Marie Stopes UK is a charity that provides abortion services.

They offer a remote service for women less than 10 weeks gestation, where consultations are held by telephone and medication are issued remotely to be taken at home.

Question 9

how can abortion services be accessed?

Answer 9

by self-referral or by GP, GUM or family planning clinic referral.

Question 10

what are grounds of abortion at any time during pregnancy?

Answer 10

1. Continuing the pregnancy is likely to risk the life of the woman
2. Terminating the pregnancy will prevent “grave permanent injury” to the physical or mental health of the woman
3. There is “substantial risk” that the child would suffer physical or mental abnormalities making it seriously handicapped

Question 11

what is the dose/route of mifepristone (and alternative name)

Answer 11

oral 200mg
often referred to as RU486

Question 12

what is the dose/route of misoprostol?

Answer 12

Misoprostol (200µg).
4 tablets in to your vagina (usually at home)
The 4 tablets provide the required dose of
800 µg.