TOP Flashcards
What are the grounds for abortion?
HSA1 (2 Drs)
A - risk to life of pregnant woman
B - to prevent grave permanent injury to pregnant woman
C - <24wks and risk of injury to woman
D <24wks and risk of injury to existing children
E - risk of child being seriously handicapped
HSA2 (emergencies - 1 Dr)
F - save pregnant woman’s life
G - prevent grave permanent injury to pregnant woman
What to offer/discuss before TOP
- counselling and support
- written info
- US only if indicated (confirm gestation, identify non-viable/ectopic pregnancy)
- screen for chlamydia +/- other STIs
- Abx prophylaxis if indicated
- discuss contraception
- bloods if indicated: Hb, ABO + Rh group +/- HIV/hep B&C, haemaglobinopathies
- anti-D if Rh-ve
- NSAIDS +/- codeine
- 24h helpline number
- F/U - self-test or scan depending on gestation etc.
When to give Abx prophylaxis in TOP, and what to give
- if medical and increased risk STI, or any surgical
- doxycycline or azithromycin
When to give Anti-D in TOP?
ALL TOP regardless of gestation or method
What does medical TOP involve?
- mifepristone orally
- followed 24-48h later by misoprostol orally, bucally, sublingually or vaginally
When to give misoprostol in medical TOP
- 24-48h if <10wks
- 36-48h if >10wks
Who can take the misoprostol at home?
Gestation <10+1
When can medical termination take place?
any gestation within the law
When can vacuum aspiration take place?
7-15wks
When can dilatation and evacuation take place?
14-24wks
What cervical preparation is used before surgical TOP?
<14wks: misoprostol
14-18wks: osmotic dilators (or misoprostol)
>18wks: osmotic dilators
When should feticide be performed?
all medical abortions from 22wks
What is used for feticide?
- 3ml intracardiac 15% potassium chloride (+/- anaesthetic and or muscle relaxant instillation beforehand to stop fetal movement)
- alternative is intracardiac digoxin
