Termination of Pregnancy

Question 1

A 16-year-old female came in to your GP practice asking for a referral for abortion. How would you counsel and manage the patient? Discuss time limits for abortion, ethical, legal aspects

Answer 1

Impression
Salient features is 16 year old believes she is pregnant and is asking for abortion.

Important initial considerations

• confirm pregnancy, identify gestational age, risk factors
• assess for competency and capacity in medical decision making given age of patient (<14 then requires parent/guardian consent)

Goals:
- therapeutic alliance, thorough assessment, counsel patient, legal framework

Question 2

Termination of Pregnancy - History

Answer 2

History
Conductt in quiet environment, include family members if requested or in person if not, confirm confidentiality and patient autonomy.
- assess competence: “Gillick competence” (14-16yrs)
PC: LMP/gestational age, confirm pregnant, planned vs unplanned, why abortion, any screening/scans conducted
- sx: exclude Red flags in bleeding, vaginal discharge, pelvic/abdominal pain, fevers
- contra to TOP: long-term steroids, IUD, no support at home, chronic adrenal failure, coagulopathy
- O&G history: GTPAL, STI, hx
- PMHx:
- Psychosocial history: MH screen, family/partner support, home life, education, drugs/alcohol

Question 3

Termination of Pregnancy - Examination

Answer 3

Examination

• general appearance + vitals
• abdominal palpation, fundal height, FHR doppler, BP

Question 4

Termination of Pregnancy - Investigations

Answer 4

Investigations
Key/diagnostic:
- confirm pregnancy with urine and serum ß-HCG
- bloods: FBC, UEC< Rh status, TORCH serology and others (Syphilis, HIV, Hep B, Varicella), coags

opportunistic sexual health screen (STI)

Question 5

Termination of Pregnancy - Management

Answer 5

Management
- pre-termination counselling
o psychology +/- social work input
o education regarding process of abortion (medical vs surgical) - type of abortion will depend on gestational age
o discussion of medical vs procedural options (benefits, risks, complications)
o cost: public vs private

can get involvement of reproductive/sexual health nurse,

Supportive:
- antenatal care: folic acid and vitamin supplements,

Definitive

• medical: misoprostol + mifepristone
• surgical: vacuum curettage

Question 6

Termination of Pregnancy - Legal framework

Answer 6

Legal Framework
In NSW;
- <22wks gestation anyone can get an abortion as long as they can provide informed consent
- >22wks gestation: termination only done by specialist, there must be sufficient grounds for termination (medical reasons

Practitioners who conscientiously object to supplying abortions to patients must inform the patient of their own preferences, and provide referral to a service where abortions can be provided.