Counseling -- Termination of pregnancy.
Introduction:
Questions to be asked before TOP:
How are you? Are you sure that you are pregnant?
Why do you want a termination? I don't mean to be intrusive but why have you considered this?
You have to live with the decision for the rest of your life. Have you discussed with your partner?
Have you considered the other alternatives like adoption of the baby?
If she chooses TOP: I will have to examine you and do a screen to confirm that you are pregnant. (Investigations: chlamydia, cervical smear, bloods for Rh and grouping. If Rh -ve give Anti D to prevent problems in the future).
When was your last cervical smear?
Is your menstrual cycle's regular? LMP?
Are you on any contraception?
Is this a planned or unplanned pregnancy?
Any previous TOP?
Are you having any medical problems? Are you on any medication?
H/o smoking and alcohol.
Mrs. Smith as you are >9 weeks pregnant the TOP is done under general anesthesia. The (neck of the womb) cervix is dilated and the womb is evacuated. When you wake up it may be sore and bleed. If there are no problems you can go home the same day.
The complications associated with TOP are heavy bleeding, rarely perforation of the womb, infection (affects the tubes and may lead to infertility) and rarely incomplete removal.
Contraception: You can start the pill tomorrow if you wish.
For 2nd trimester abortions, labour is induced using intravaginal prostaglandin gel or pessaries eg. Gemeprost. Oxytocin to stimulate contractions and surgical removal of retained placenta.
After 14 weeks mortality and morbidity raises steeply with gestation.
4-stage medical TOP: (gestation <9wks) counseling and USG, supervised mifepristone 600mg PO disimplants the conceptus (CI: smokers >35yrs old; avoid aspirin and NSAID's for 12 days). A gemeprost 1mg pessary 36-48h later completes abortion. Follow up and scan at 12 days.