ToP

Question 1

What gestation is termination of pregnancy permitted up until in England and Wales?

Answer 1

23+6/40

Question 2

97% of terminations of pregnancy are performed under which clauses of the abortion act?

Answer 2

C

Question 3

What assessments/investigations are routinely required before ToP?

Answer 3

Assessment of gestation
USS if >10/40 by LMP, uncertainty of dates, or pain/bleeding
STI risk assessment and offer screen, 
Rh status if STOP or >10/40, 
VTE risk assessment. 
FBC only if clinically indicated.

Question 4

How long after early pregnancy loss can cervical screening take place?

Answer 4

12/52 (although some say 6/52)

Question 5

What antibiotics are indicated following mtop at 9/40?

Answer 5

None. No routine antibiotics at MTOP now.

Question 6

Which antibiotics are indicated following STOP at 9/40?

Answer 6

3/7 100mg BD/PO doxycycline.

Question 7

When is anti D required after STOP/MTOP?

Answer 7

MTOP <10/40 not required, MTOP >10/40 and all STOP required.

Question 8

Which blood group receive anti D where indicated?

Answer 8

Rh negative

Question 9

Contraception is required from how many days post TOP?

Answer 9

5/7.

Question 10

Which analgesics are recommended for TOP?

Answer 10

NSAIDS, >3/40 narcotics.

Paracetamol no evidence but use ?synergistic

Question 11

What is the upper gestational limit for MVA?

Answer 11

12/40 (some surgeons will do 14/40)

Question 12

STOP as an evac can be done up to what gestation?

Answer 12

14/40 (large bore canual can be 18/40 but not recommended)

Question 13

Foeticide is required after what gestation?

Answer 13

> 22/40

Question 14

D & E is recommended from what gestation?

Answer 14

> 14/40 under ultrasound guidance

Question 15

What is the mechanism of action of mifepristone?

Answer 15

SPRM, antiprogesterone, sensitises the uterus to prostaglandins

Question 16

What is the dose if mifepristone?

Answer 16

200mg

Question 17

What long between mifepristone and misoprostol is recommended?

Answer 17

24-48hrs, can be given together but slightly increased failure rate

Question 18

What is the initial dose of misoprostol for MTOP?

Answer 18

800mcg.

Question 19

What is the dose of misoprostol subsequent doses for MTOP?

Answer 19

400mcg 3 hourly buccal

Question 20

If no POC are passed at MTOP and multiple pulses of misopristol have been given what are the options?

Answer 20

Rest for 12+ hours and retry or STOP.

Question 21

What is the failure rate of MTOP?

Answer 21

1/100 failure rate increases with gestation

Question 22

What is the risk of RPOC at MTOP >14/40?

Answer 22

13%

Question 23

What is the risk of RPOC at MTOP <14/40?

Answer 23

5%

Question 24

Risk of heavy bleeding with mtop?

Answer 24

1/1000

Question 25

Risk of infection at MTOP?

Answer 25

1/100

Question 26

Risk of C/S scar rupture at MTOP?

Answer 26

1/200

Question 27

Risk of uterine rupture at MTOP?

Answer 27

1/1000

Question 28

Contraindications to MTOP?

Answer 28

Liver enzyme inducers, severe asthma on glucocorticoids, porphoria, chronic renal failure, coagulopathy, beware of cardiac problems risk assess individually.

Question 29

Follow up after MTOP?

Answer 29

Low sensitivity PT 3/52

Question 30

What cervical priming is recommended <14/40?

Answer 30

400mcg misoprostol PV at least 1 hour before pr if buccal 3 hours before.

Question 31

Osmotic dilators are recommended for STOP after what gestation?

Answer 31

14/40 (can be miso up to 20/40 but less effective

Question 32

Is histology of the POC recommended for routine STOP?

Answer 32

No.

Question 33

Risk of severe bleeding at STOP?

Answer 33

1/1000

Question 34

Risk of infection at STOP?

Answer 34

1/100

Question 35

Risk of perforation at STOP?

Answer 35

1-4/1000

Question 36

Risk of cervical trauma at STOP?

Answer 36

1/100

Question 37

Risk of failure with STOP?

Answer 37

1/1000

Question 38

Risk of PROC at STOP?

Answer 38

<5%