Termination of Pregnacy (TOP, Abortion)

Last updated 20.09.12

 

Definition

-  Deliberately ending a pregnancy so it does not progress to birth

-  In Australian defined up to 24/40  

-  STOP = Surgical Termination Of Pregnancy

 

Features

-  1/3 women at some point (Aus)

-  Outcome of 1/4 pregnancies

-  Majority performed in 1st trimester

-  Suction D&C most common method

 

Procedure

-  Confirm pregnancy

-  Hx, exam, +/- ultrasound, beta hCG

-  Avoid unescessary proc

-  Look for ectopics

-  Blood Group & Rhesus status

-  +/- Abx prophylaxis

-  Anaesthesia

-  IV sedation (Midazolam) w LA into cervix (Lidnocaine) or GA

-  1st Trimester TOP

-  Suction D&C used up to about 15/40

-  Mifepristone RU486 (medical) <9/40 not available in Australia

-  Misoprostol

-  2nd Trimester TOP: Dilation & Evacuation (D&E)

-  Day 1

-  Laminaria inserted into cervix under anaesthetic

-  Cervix dilates overs hours/day

-  Day 2

-  Medication to further soften cervix

-  Anaesthesia

-  Ultrasound to confirm location of embryonic sac

-  Manual cervical dilation

-  Products removed with forceps

-  Examination of products

-  +/- products sent to histopathology 

-  Treat Rhesus –ve women with Anti-D

-  Counselling

-  Contraception advice

 

Complications

-  Perforation of uterus 0.1%

-  Tearing of cervix

-  Heavy blood loss

-  Cramping post op

-  Infection < 10%

-  Retained products < 1%

-  Long term risks

-  Future miscarriage

-  Preterm births

-  Placenta praevia

 

 

 

References

 

RANZCOG: Termination of Pregnancy, November 2005

RANZCOG TOP Resource for Health Professionals 2005

Marie Stopes Foundation