This document discusses termination of pregnancy, including definitions, types of miscarriage, induced abortion guidelines, pre-abortion management, methods of abortion, complications, Rh prophylaxis, ectopic pregnancy management, and management of anomalous fetuses. It outlines the legal framework for induced abortion in the UK, categories for legal termination, and guidelines from NICE and RCOG on counseling, testing, methods, and follow up for abortion and ectopic pregnancy treatment.

1. TERMINATION OF PREGNANCY
Dr. Farwa Ashfaq (PGT)
Dr. Muqqadas (HO)
Ref: NICE Guidelines

2. DEFINITION
 Deliberate removal of embryo/fetus from uterus
before stage of viability

3. FETAL INDICATION

4. MATERNAL INDICATION

5. TYPES OF MISCARRIAGE

7. INDUCED ABORTION
 Abortion act 1967:
-must be performed within an NHS hosp./ approved
clinic.
-CMO must be informed.
-two RMPs must certify that operation is being
performed for grounds specified in the act.
 Amendments by HFEA in 1990:
5 categories:
1. continuance of pregnancy  risk to life of
woman.
2. TOP is necessary to prevent grave injuries to
physical and mental health of pregnant lady.

8. 3.pregnancy has not exceeded 24 weks risk of
mental and physical harm to mother.
4. pregnancy has not exceeded 24 weks  risk of
mental and physical harm to children.
5. Physical / mental abnormality of fetus.

9. PRE-ABORTION MANAGEMENT
 Counseling andd discussion of method being used.
 Full medical history
 USG to confirm intrauterine pregnancy and its GA.
 Blood group, cbc, pt-aptt
 Chlamydia screening all +ve should have STI
screening, contact tracing and treatment of both
partners
 Contraceptive cunseling
 Antibiotic prophylaxis in case of surgical methods.

10. PERI-ABORTION PROPHYLAXIS
 Metronidazole 1g rectally/ 800mg orally prior to or
at time of abortion
PLUS
Doxycycline 100mg 1 x BD x 7 days from day of
abortion
 OR
Metronidazole 1g rectally/ 800mg orally prior to or at
time of abortion
PLUS of abortion
Azithromycin 1gm PO x stat at time of abortion

11. METHODS
 Expectant
 Medical
 Surgical
D&E
Vaccum aspiration (electrical/manual)

12.  Upto 9 weeks- early medical termination
 Upto 10-11 weeks- MVA
 From 6-16weeks- vacuum aspiration under
local/GA
 Above 14 weeks- D&E (cx preparation)
 9+ to 24weeks- Medical Method
UNLISCENCED Regimen: for <9weeks mifepristone
200mg PO f/b misoprostol 800mg vaginally/
sublingually 36-48hrs later.
2nd dose of 400ug of misoprostol after 4 hrs.
For 9-24weeks- repeat max of 4 doses 3hrs apart(
depends on vaginal bleeding)

13. COMPLICATIONS
 RPOCs (confirmed on scan): surgical evacuation
 Haemorrhage (1 in 1000to 4 in 1000 at 20+weeks)
 Uterine perforation
 Uterine Rupture (mid- trimester miscarriage)
 Cervical trauma( cx preparation reduces risk)
 Failed Abortion
 Post- abortion infection
 Future reproductive outcome(small risk of
subsequent miscarriage/preterm labour)

14. RHESUS PROPHYLASIS
 For all non sensitized Rh-ve women, anti-D Ig
shoulde be given within 72 hrs.
250 IU before 20 weeks of gestation
500IU thereafter
no ati-D if medical TOP is done before 10 weeks.
But for surgical TOP it should be given. (RCOG)
 Pre- abortion contraceptive counseling should be
done
 f/up in case of emergency otherwiswe routine f/up
after surgical abortion is not necessary.

15. ECTOPIC PREGNANCY
 3 management options depends on clinical
condition and future fertility requirement.
EXPECTANT
offered to women with small <3 cm non ruptured
ectopic pregnancy without FCA and BHCG <
1500IU/L.
success rate 76-88%

16. SURGICAL
main treatment for Tubal pregnancy especially with
significant bleeding.
RCOG and NICE recommends laproscopic approach
whenever possible.
 2 options: salpingectomy/ salpingostomy
salpingostomy should be offered if C/L tube is already
damaged/removed and female wants to conserve
fertilty may require further medical Tx or
salpingectomy.
 Salphingectomy is done if:
adnexal mass > 35mm
significant pain
ectopic pregnancy with FHR +ve on scan
BHCG > 5000IU/L
hyovolemic shock

17.  MEDICAL
if patient is hemodynamically stable
-asymptomatic
-unruptured small ectopic <35mm and no FCA
-no intrauterine pregnancy on scan
-able to continue f/up visits
Methotrexate Regimen:
inj. Methotrexate 50mg/m2 OR 1g/kg x IM
serial BHCG levels until <20IU/L
More than 1 dse is required in 14-26% cases.

18. ANOMALOUS FETUSES
 1st trimester: vaccum/ D&E
 Medical treatment acc to FIGO protocol in 2nd and
3rd trimester.

20. THANK YOU