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Termination of
pregnancy (UK Law
(Abortion
Act 1967) (Categories…
Termination of
pregnancy
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UK Law
(Abortion
Act 1967)
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Categories
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Category C
Commonest used
Pregnancy <24w and would risk injury to
mental/physical health of mother >termination
Category D
Pregnancy <24w and would risk injury to mental/physical health of the mother's current children
Category E
Risk that child would suffer from physical/mental
abnormalities as to be seriously handicapped
GMC Guidance
Dr personal beliefs
Ensure personal beliefs do not prejudice patient care
Right to refuse to TOPs (conciencious objection) but
must refer patient to another doctor who can help
Patients <16y
Encouraged to involve parents
If Fraser competent, can give own consent
If <13y, classified as rape and should involve SS
Management
Medical
Antiprogesterone plus PG analogue
Indication: preferred method <9w; can be used 9-24w
E.g. mifepristone (antiprog) plus misorpostol (PG E1)
MOA: antiprogesterone causes placental bleeding and uterine contractions; PG stimulates contractions; feticide should also be considered for gestation >20w
SEs: bleeding, failed TOP, retained products, rupture
Prophylactic abx
Indication: minimising post-abortion infection
E.g. metronidazole plus doxycycline,
metronidazole plus azithromycin
Anti-D
Indication: If Rh-
MOA: prevents haemolytic disease of newborn
in patients Rh- with Rh+ foetus next pregnancy
Surgical
Dilation and evacuation
Indication: >13wk gestation
MOA: cervical preparation first (misoprostol/ gemeprost/ mifepristone) then evacuation of the products of conception;
if >24wk then feticide needed (intracardiac KCl +/- anaesthetic and muscle relaxant) to ensure foetus born dead
SEs: bleeding, incomplete evacuation, uterine perf
Suction termination
Indication: 7-13wks gestation
MOA: disruption of foetus under USS guidance
followed by aspiration of the products of conception
SEs: bleeding, failed TOP, perforation
Conservative
Counselling and support (written and verbal)
Confirm pregnancy, gestation, baseline bloods, STI screen
Discuss ongoing contraception
Follow up <2wk (USS confirmation of TOP)
Complications
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All methods
Haemorrhage
Genital tract infection
Failed TOP
Retained products
N+V, diarrhoea
Psychological (anxiety, depression)
Regret and worries on future fertility
Diagnosis
Investigations
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Imaging
USS: confirm viable pregnancy,
confirms gestational age
Bloods
FBC (anaemia)
Blood group + Abs
BBV screen (HIV, HBV, HCV) if needed
Haemaglobinopathy screen (if relevant)
Swabs
STI screen (CT, NG, VT) if needed
History
PC/HPC
Symptoms, confirmed with test
PGH
LMP, menses, contraception,
STIs, smears, TOP
POH
Gravity/parity, delivery,
dates, complications
PMH
Current conditions,
psychiatry, prev surgery
DH
Current medications, allergies
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SH
Occupation, support,
smoking, alcohol, drugs