TOP

Question 1

TOP is a relatively safe/unsafe procedure?

Answer 1

Safe

Question 2

TOP is the most commonly performed procedure in the UK. True or false?

Answer 2

True

Question 3

There is a link with TOP and social deprivation. True or false?

Answer 3

True

Question 4

What is the most common ground for termination?

Answer 4

Pregnancy has not exceeded its 24th week
Continuance of pregnancy would involve risk, greater than if pregnancy terminated, of injury to physical or mental health of pregnant woman.

Question 5

What investigations must be carried out before continuing with TOP?

Answer 5

Ultrasound Scan
- to confirm pregnancy
- to determine gestation
Bloods

Question 6

Should these patients be offered an STI test?

Answer 6

Yes

Question 7

Why should patients be offered prophylactic antibiotics?

Answer 7

Metronidazole.

To cover for chlamydia if either the STI test is +ve or if the result is not back yet

Question 8

What is the legal limit for social TOP ?

Answer 8

24 weeks

Question 9

In NHS tayside, when is medical termination available until?

Answer 9

18 weeks + 6 days gestation

Question 10

In NHS tayside, when is surgical termination available until?

Answer 10

Up to 12 weeks gestation

Question 11

In Scotland, what is the latest gestation period you can terminate pregnancy?

Answer 11

20 weeks

Question 12

If a patient who lives in Scotland is 22 weeks gestation and they want a TOP, what happens?

Answer 12

Refer to BPAS

Travel to London

Question 13

What is the legal limit for TOP of a foetal anomaly that is serious risk to life?

Answer 13

No limit - this can be done at any gestation

Question 14

What year was the abortion act introduced?

Answer 14

1967

Question 15

Who must terminate a pregnancy?

Answer 15

Registered medical practitioner

Question 16

When can an abortion take place?

Answer 16

If 2 registered medical practitioners are of the opinion that an abortion is justified

Question 17

Legal forms - Certificate A (HSA1) - who signs it

Answer 17

2 doctors sign this green form

They must have at least seen the patient

Question 18

Which certificate is used in case of an emergency abortion, where there is threat to life of woman?

Answer 18

Certificate B (HSA2)

Question 19

Who is required to sign Certificate B (HSA2)

Answer 19

1 doctor

Must be completed within 24 hours of emergency abortion

Question 20

What are the 5 domains of gillick competence?

Answer 20

Does the patient understand the information?
Must be acting in patients best interest
Must advise pt is best to tell a parent/guardian
If you withhold care, the pts physical and mental health is likely to suffer
If the pt is likely to continue to be at risk you should provide care

Question 21

What is conscientious objection

Answer 21

When doctors opt out of certain procedures because of personal beliefs/values

Question 22

Medical TOP - stage 1

Answer 22

200mg Oral Mifepristone

Question 23

Medical TOP - what is mifepristone

Answer 23

Anti-progesterone medication at a very high dose

Blocks progesterone, encouraging death

Question 24

Medical TOP - stage 2

Answer 24

Vaginal or buccal prostaglandin is administered 24-48 hrs after oral mifepristone (eg Misoprostol, gameprost)

Question 25

Medical TOP - what is the function of the prostaglandin used in stage 2

Answer 25

Used to soften cervix Encourages uterine contractions This is to expel the contents of the pregnancy

Question 26

Medical TOP - up to which gestation is there the option to complete stage 2 of the TOP at home?

Answer 26

Up to week 9

Question 27

Medical TOP - from 9 weeks onwards

Answer 27

Both stages must be completed in hospital | Repeated doses of stage 2 prostaglandins may be required

Question 28

What happens if Medical TOP fails?

Answer 28

Try surgical termination

Question 29

Surgical TOP - options

Answer 29

Cervical priming - with vaginal prostaglandin to soften cervix Electrical vacuum aspiration Manual vacuum aspiration Dilation and evacuation

Question 30

Surgical TOP - electrical vacuum aspiration is done under local/general anaesthetic?

Answer 30

General

Question 31

Surgical TOP - what is the advantage of this over medical TOP

Answer 31

Long acting reversible contraceptives can be fitted at time of procedure

Question 32

Surgical TOP - when can manual vacuum aspiration be used up until?

Answer 32

9 weeks gestation

Question 33

Surgical TOP - manual vacuum aspiration is done under local/general anesthetic?

Answer 33

Local

Question 34

Surgical TOP - procedural risks

Answer 34

``` Pain Haemorrhage Infection Incomplete/ failed procedure Cervical trauma ```

Question 35

After TOP has been carried out, what follow up investigations are required

Answer 35

Pregnancy test - 2-3 weeks post TOP

Question 36

What do you do if patient is rhesus -ve?

Answer 36

Give Anti-D within 72 hours

Question 37

Contraception

Answer 37

All methods should be available and initiated on site prior to discharge

Question 38

Why do you avoid giving depo injections with mifepristone?

Answer 38

Depo injections contain high dose progestogen Mifepristone is an anti-progestogen therefore, the depo injection may prevent the mifepristone from working