Unplanned pregnancies are associated with poorer outcomes for mother and baby than if intended/planned
30-40% of unintended pregancies end in abortion
Investigations
Estimation of gestation
Clinical
Estimated by LMP +/- date of positive UPT
Palpable uterus (> 12 weeks)
Ultrasound
Abdominal or transvaginal (> 6 weeks)
Frequently used for all pre-COVID
Now via risk assessment - symptoms/risk factors of ectopic, uncertainty about dates, before surgical termination
Management
Legal aspects of abortion
Abortion is certified under HSA1 form
Clause C - up to 23+6 weeks
The continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman
Clause E - no gestational limit
There is substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped
Methods of abortion
Medical - mifepristone PO, then misoprostol PO 24-48 hours later
Sugical - < 14 weeks electric (GA) or manual vaccum aspiration (LA), > 14 weeks dilation and evacuation
Choice depend on gestation, patient preference and regional avaliability
Prophylaxis at time of abortion
Antibiotic prophylaxis given to those undergoing STOP and those undergoing MTOP with increased risk of STI
Rhesus iso-immunisation
VTE prophylaxis
Risk assessment - if high risk, consider LMWH 1/12 weeks after abortion
Women at very high risk may be started on LMWH before the abortion +/- continue for longer
Contraception after abortion
Almost all methods can be started at/soon after abortion - immediately effective if started within 5 days of abortion
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