and Paula Briggs2
(1)
Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
(2)
Sexual and Reproductive Health, Southport and Ormskirk Hospital, Southport, UK
Definition
Therapeutic termination of pregnancy is defined as the use of an instrument or a hormone or chemical to abort a pregnancy. This is also known as a therapeutic abortion.
Incidence
TOP is a common procedure, with nearly 200,000 therapeutic abortions performed in the UK in 2011. It is not uncommon for women to have more than one abortion- more than one third of the women treated in 2011 had had a previous abortion.
Aetiology and Pathogenesis
There are two separate “types of reasons” for a request for TOP:
Abnormality of the foetus – e.g. chromosomal abnormality. This is not preventable, and with the recent advances in antenatal diagnosis, more abnormalities will be diagnosed in the early stages of pregnancy, providing the option for TOP to prevent the birth of an affected child.
The woman feels that she cannot continue with the pregnancy for psychological reasons. The most common reason for this is that the pregnancy was not planned.
This might occur because:
No contraception was used or the method of contraception failed.
The efficacy rate of any contraceptive choice depends on method effectiveness, with perfect use and method effectiveness with typical use (that is the ability to use the method according to instructions).
Clinical Profile
History
When did the woman have her last normal menstrual period (LNPM)?
Were her cycles regular? (the approximate date of conception, and therefore the estimation of gestation is more reliable if cycles were regular)
The use of previous contraception should be documented. This is not to apportion any blame, but to ensure the provision of a reliable method of contraception for the future.
Part of the consultation for a TOP should include the provision of ongoing/future contraception to minimise the risk of a further unplanned pregnancy (see Chap. 15).
Any medical factors, which may effect whether a medical or surgical method is used, to terminate the pregnancy should be recorded.
A VTE risk assessment should be offered.
Examination
Routine abdominal, speculum and bimanual examination should still be undertaken, but has been superceded by the use of U/S as a clinical tool.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
