Termination of pregnancy (medical and surgical) Flashcards
What are the parts of the Abortion Act 1967?
o [A] Continuation of pregnancy involves risk to pregnant woman greater than if pregnancy were terminated
o [B] Termination necessary to prevent grave permanent injury to physical/mental health of pregnant woman
o [C; majority] Pregnancy has not exceeded 24th week and continuance of the pregnancy would involve risk, greater than if pregnancy were terminated, of injury to the physical or mental health of the pregnant woman
o [D] Pregnancy has not exceeded its 24th week and continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the existing children of the family of the pregnant woman
o [E] There is substantial risk that if the child were born it would suffer from physical or mental abnormalities
o [EMERGENCY; F] To save the life of the pregnant woman; or
o [EMERGENCY; G] To prevent grave permanent injury to the physical or mental health of the pregnant woman
What are the complications of TOP?
o Generic: infection (10%), bleeding (1%), damage to local structures, failure, anaesthetic complications
o Cervical trauma (increased risk of cervical incompetence with late terminations)
o Retained products of conception
o Uterine perforation
What is the mortality rate of TOP?
mortality <1 per 100,00
How do you deal with a TOP request?
o Before TOP:
§ Screen for Chlamydia and other STI if indicated
Check Rh status
§ Assess VTE risk
Bloods – FBC, GS, haemoglobinopathy
§ Discuss future contraceptive needs – OCP or IUCD
ABx prophylaxis
o All of this needs to be offered within 5 working days of referral
o Time from seeing GP to having a TOP should be less than 2 weeks
o Offer referral to counselling service at abortion clinic
o Council all patients on long-term contraceptive advice (copper IUD, LNG-IUS, Nexplanon)
Who needs to sign for TOP?
2 doctors need to sign the form agreeing to TOP (unless emergency)
What are the options for TOP dependent on?
How far along the pregnancy is
What are the medical options for termination?
Only use misoprostol alone in missed or incomplete miscarriage
§ 2 pills: 200mg MIFEPRISTONE (oral) -> 24-48hrs later prostaglandin (MISOPROSTOL; oral)
· 0-9 weeks -> administer at home (bleeding for 2w after abortion)
· 9-24 weeks -> administer in clinic + repeat misoprostol 3-hourly (max: 5 doses) until expulsion
· ≥22 weeks -> use FETICIDE (intracardiac KCl injection)
§ Offer NSAID for analgesia
§ SE: nausea, diarrhoea, light PV bleed, cramps Mifepristone = terminates foetus
Misoprostol = expulsion of foetus
What are the surgical options for termination?
§ <14 weeks: misoprostol (400mcg vaginal/sublingual -> dilate), ERPC (vacuum aspiration) + hCG level
· Local anaesthetic and can go home same day
§ >14 weeks: misoprostol (400mcg vaginal/sublingual -> dilate), D+C (dilatation + curettage)
· Under LA or GA -> may be able to go home same day
· SE: cramps
How do you council the patient?
Call the 24hr helpline if…
§ Smelly discharge
§ Fever
§ Symptoms of pregnancy (nausea, mastalgia)
What is the RCOG overview?
