TOP management

Question 1

What is the medical management for termination of pregnancy?

Answer 1

Medical management involves 200 mcg mifepristone (oral) followed 24-48 hours later by misoprostol (vaginal, buccal, or sublingual).

Question 2

What is the dosage and administration of mifepristone and misoprostol for termination of pregnancy?

Answer 2

200 mcg mifepristone (oral) followed 24-48 hours later by misoprostol (vaginal, buccal, or sublingual).

Question 3

Is medical management suitable for any gestation?

Answer 3

Yes, medical management is suitable at any gestation.

Question 4

What should be recommended for pain management during medical termination of pregnancy?

Answer 4

Simple analgesia is recommended as the onset of contractions to expel the foetus can be painful.

Question 5

What is the protocol for medical termination of pregnancy at 0-9 weeks?

Answer 5

At 0-9 weeks, medical termination can be administered at home provided the patient is easy to follow-up and can seek medical attention if necessary. Bleeding usually starts within 4 hours of misoprostol and continues for up to 2 weeks. A urine pregnancy test is recommended in 2-3 weeks.

Question 6

What is the protocol for medical termination of pregnancy at 9-13+0 weeks?

Answer 6

At 9-13+0 weeks, 200 mcg mifepristone is followed by 800 mcg misoprostol (vaginally). This should be done in a clinical setting. Repeated doses of 400 mcg misoprostol are usually needed every 3 hours until expulsion (maximum 5 doses).

Question 7

What is the protocol for medical termination of pregnancy at 13-24+0 weeks?

Answer 7

At 13-24+0 weeks, 200 mcg mifepristone is followed by 800 mcg misoprostol 36-48 hours later, then 400 mcg misoprostol every 3 hours for a further four doses.

Question 8

What special consideration should be given after 21+6 weeks during medical termination of pregnancy?

Answer 8

After 21+6 weeks, feticide (intracardiac KCl injection) should be given to eliminate the possibility of the aborted foetus showing any signs of life.

Question 9

What is vacuum aspiration and when is it used?

Answer 9

Vacuum aspiration is used for termination of pregnancy < 14 weeks. It involves gently dilating the cervix and using vacuum suction to evacuate the uterus. It can be performed under local or general anaesthetic, and the cervix is usually pre-treated with misoprostol.

Question 10

What is dilation and evacuation (D&E) and when is it used?

Answer 10

Dilation and evacuation (D&E) is used for termination of pregnancy at 13+0 – 24+0 weeks. It requires good cervical dilation to remove larger foetal parts. Misoprostol is used to ripen the cervix 3 hours before surgery, and the contents of the uterus are extracted using aspiration and other instruments (e.g., forceps). Ultrasound is required to confirm evacuation.

Question 11

What are the risks associated with surgical management of termination of pregnancy?

Answer 11

Risks of surgical management include failure to end pregnancy, haemorrhage, infection, and perforation.

Question 12

Does surgical management of termination of pregnancy affect future reproductive potential or risk of ectopic pregnancy?

Answer 12

No, surgical management of termination of pregnancy has no effect on future reproductive potential or risk of ectopic pregnancy.

Question 13

What contraception should be discussed with all abortion patients?

Answer 13

Discuss the insertion of long-acting reversible contraception (e.g., copper IUD, LNG-IUS, Nexplanon) with all abortion patients.

Question 14

How many doctors need to sign a form agreeing to termination of pregnancy?

Answer 14

Two doctors need to sign a form agreeing to the termination of pregnancy, although they do not both need to see the patient.

Question 15

When should anti-D prophylaxis be offered to women having an abortion?

Answer 15

Anti-D prophylaxis should be offered to all rhesus D negative women having an abortion after 10+0 weeks GA.

Question 16

How should the options for termination of pregnancy be explained to patients based on gestation?

Answer 16

Explain that the best option is dependent on how many weeks pregnant they are. Higher gestation means more pregnancy tissue, which influences the choice between medical and surgical options.

Question 17

What should be included in the risk assessment for termination of pregnancy?

Answer 17

Risk assess for chlamydia and other STIs as appropriate.

Question 18

What is the expected duration of bleeding after medical termination of pregnancy?

Answer 18

Bleeding can last about 2 weeks after medical termination of pregnancy.

Question 19

What follow-up is recommended after medical termination of pregnancy?

Answer 19

A pregnancy test is recommended 2-3 weeks after medical termination of pregnancy to confirm that the pregnancy has ended.

Question 20

What is the process of surgical termination of pregnancy?

Answer 20

Surgical termination involves gently dilating the cervix and removing the pregnancy tissue using a suction tube. The procedure only takes about 10 minutes and can be done under local or general anaesthesia. The cervix may need to be ripened beforehand.

Question 21

What support should be offered to women after an abortion?

Answer 21

Explain that it is common to feel a range of emotions after an abortion and provide resources and sources of support, such as counselling or psychological interventions.