TOP

Question 1

Criteria for termination (4)

Answer 1

<24wks and continuation has greater risk to physical/mental health of mother/existing children.

if termination prevents permanent grave injury to mother’s physical/mental health

if continuing pregnancy poses a risk to the mother’s life

if the foetus is likely to become severely handicapped

Question 2

Before TOP (5)

Answer 2

must check for intrauterine pregnancy

screen for chlamydia-increased risk of post-op salpingitis

pre-abortion bloods: FBC, ABO/rhesus, coagulopathies, HIV, HBV. Anti-D if rh -ve.

post-op prophylactic Abx-metronidazole+azithromycin

counselling on contraception

Question 3

Medical TOP (4)

Answer 3

anti-progesteron: mifepristone +prostaglandin: misoprostol:

• mifepristone displants the foetus
• misoprostol expels the foetus
• if <9wks can take both on same day, if >9wks take misoprostol 1-3d after

ensure sufficient analgesia w. NSAIDs

will require feticide at 22wks w. potassium chloride

NB:

• if >24wks, considered stillbirth and needs registering
• if signs of life, will require death certificate
• medical TOP considered late if >9wks and early if <9wks

Question 4

Surgical TOP (5)

Answer 4

pre-op cervical priming w. misoprostol if:

• > 10wks gestation
• <18yrs old

analgesia w. NSAIDs

prophylactic Abx: metronidazole+azithromycin

vacuum aspiration:

• 7-13 wks
• under LA

dilatation and evacuation:

• 13-24wks
• under GA
• USS used
• requires priming

NB: no impact on fertility

Question 5

After TOP

Answer 5

must do pregnancy test 3wks later

Question 6

common complications of TOP (3)

Answer 6

infection-azithromycin+metronidazole

retained products

cervical trauma

Question 7

rare complications of TOP (4)

Answer 7

haemorrhage-increased risk with more advanced gestation

uterine perforation/rupture

failure of TOP

slight increased risk of premature labour in future pregnancies if surgical