Termination of Pregnancy

Scope

  • Termination of pregnancy (TOP) or induced abortion by medical or surgical methods up to 24 weeks gestation, in the Northern Locality
  • Includes assessment, investigation, consent and counselling

Out of scope

  • Spontaneous or threatened miscarriage
  • TOP beyond 24 weeks
  • TOP for fetal anomaly or intrauterine fetal death
  • Genetic counselling

Investigations

Basic investigations should be carried out according to the local care pathway but as a minimum should include:

  • Clinical examination to confirm gestational age

The following may be performed in primary care, or after referral to secondary care, as per local protocol:

  • Chlamydia screening
  • Blood group and save

Advise the patient regarding the cervical screening programme and arrange screening if appropriate (this should not delay pregnancy termination)

There are three strategies for dealing with STIs and the choice between these approaches depends on local protocol and the prevalence of infections:

  • A screen and treat strategy (treat those women found to have an infection with an appropriate antibiotic)
  • Routine antibiotic prophylaxis for all women
  • A combination of screen and prophylaxis:
    • this allows prophylaxis in all cases but also enables partner notification and screening for other STIs

​Management

Offer support and counselling

In order to give valid informed consent to termination, the patient should be fully informed about the options available and be given further support and counselling as appropriate to her needs:

  • Assess the patient's situation and feelings about termination
  • Explore options available, e.g. continuing pregnancy, adoption
  • If necessary, allow time to make a decision, although the clinician must respect the fact that the woman may already have made her decision, in which case the referral should not be delayed
  • Inform the woman that she can change her mind until the actual procedure
  • Explain the procedure and what to expect, discuss after care and contraception
  • Reassure the woman that there is no association between a single abortion and an increased risk of psychological sequelae unless there are pre-existing risk factors
  • Inform the woman about the process for informing of a positive sexual transmitted infection (STI) screen

When giving the woman the information and counselling:

  • Counselling should be unbiased and non-judgemental
  • If an interpreter/signer for the deaf is used, they must be an independent person and not a family member
  • Written information should be provided that is impartial, easy to understand and translated if necessary
  • Emphasise confidentiality

Offer the patient time to consider their decision, and arrange a review appointment if the patient wishes:

  • Respect the fact that the woman may already have made her decision, in which case the referral should not be delayed

If the woman does want more time to consider the decision, with the woman's agreement consider:

  • Booking an appointment with an abortion provider for assessment and information, with no need to book a date for the procedure, as abortions that are performed earlier are safer

If Patient less than 100% sure to proceed with termination of pregnancy

  • Refer to specialist counsellor if indicated and continue with pregnancy, make appointment with the midwife in Primary Care

Referral

Referral Instructions

For referral to TOPS clinic

The TOPS clinic is run by NDDH and referral should be made to the TOP triage service by telephoning: 01271 322602 / 322786

Counselling Services NDDH - 01271 341562

Please be aware BPAS services are available in Devon.

BPAS website - 08457 30 40 30

Other local services are available at RD&E

  • GP should contact the department on 01392 406503 to initiate referral.

Supporting Information

This guideline has been signed off by the Northern Locality on behalf of NEW Devon CCG.

Publication date: August 2018

 

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