termination of pregnancy

Question 1

What are the different types of abortion available

Answer 1

Early surgical under protocol	     < 7
Early medical abortion(MTOP)	     < 9
Manual Vacuum Aspiration	< 9
Suction Termination (STOP) 	  7 - 14 (mostcommon)
Dilatation & Evacuation		15 - 18
Mid-trimester medical abortion	14 - 24
Two stage surgical procedure	19 - 24

Question 2

Describe early medical abortion

Answer 2

Medical abortion using Mifepristone plus prostaglandin is an appropriate method at any gestation under 9 weeks

Mifepristone 200mg PO
Admit 36 - 48hrs later
Misoprostol 800mcg PV

Given for gestations between 9 and 12 (unlicensed)

Advantages of EMA:
Seemed a more ‘natural’ experience 
No surgery or anaesthesia was needed
It afforded more privacy 
Perceived to be less frightening and easier emotionally than a surgical abortion
Required a shorter stay in hospital
It was easier, simpler and faster

Question 3

Describe suction termination

Answer 3

Suction termination of pregnancy should be avoided at gestations of < 7 weeks. No longer the case.
Conventional suction termination is an appropriate method at gestations of 7 – 15 weeks
Cervical preparation is beneficial prior to suction termination
Suction termination may be safer under local anaesthesia than general - MVA

Question 4

Describe manual vacuum aspiration

Answer 4

OPD setting
LA
Suitable for patient keen on the procedure
Shorter stay in the hospital
Needs skilled, training and awareness as patient is awake
Needs committed staff to support the patient
Saving money for the NHS

Question 5

What are some complications in surgical abortions

Answer 5

Immediate complications:
Anaesthetic
Uterine perforation - 0.8 / 1000
Cervical Tears
Primary haemorrhage
Uterine rupture
Death - rare -  0.6 / 1,000,000

complications after discharge:
Failed abortion 
Retained products of conception ~ 1 : 100
Secondary haemorrhage
Ectopic pregnancy
Pelvic infection

Question 6

Describe abortion care to prevent pelvic inflammation

Answer 6

Screen all women 
	 Chlamydia/Gonorrhoea
	Treat positives
Doxycycline/Azithromycin
    Contact tracing

 HIV 
Treatment

Question 7

Complications of late induced abortions

Answer 7

Tubal factor infertility
Rhesus Iso-immunisation
Psychological and psychosexual sequelae

psychological complications:
Regret and early distress common
Adverse sequelae occur only in a minority
Continuation of problems present before abortion
Long term post abortion distress risk factors
Unsupportive partner
Ambivalence before abortion
Prior psychiatric history
Considers abortion wrong

Question 8

Describe after care for induced abortion

Answer 8

Anti-D prophylaxis
Written information
Contact numbers
Counselling services
GUM follow up
Contraception advice and provision
Follow up appointment within 2 weeks

Question 9

Financial side of getting an abortion vs contraception

Answer 9

NICE guideline (2005) which highlights that if 7% of women switched from the contraceptive pill to Long Acting Reversible Contraceptive (LARC) methods (defined as the intrauterine device (IUD), hormonal injection, intrauterine system (IUS) and contraceptive implant) the NHS could save around £100 million through reducing unintended pregnancies by 73,000.
In February, 08/09  the Public Health Minister, announced £26.8m new funding for from the Comprehensive Spending Review to improve access to contraception.

Question 10

Describe feticide

Answer 10

For abortions at 22 weeks or beyond, feticide is recommended prior to the evacuation of the uterus to stop the fetal heart.
In 2012, of the 1,312 abortions performed at 22 weeks and over

Complications:
278 cases in 2012, a rate of about one in every 700 abortions, the same as in 2011 and
41 per cent lower than in 2002
There were no deaths following abortion reported in 2012.