Termination of Pregnancy

Topics: Obstetrics, Pregnancy, Abortion Pages: 10 (1579 words) Published: November 30, 2011
MSc in Cardiology 2010-2011-CVSM 5001 Basic Cardiology (28 Dec 2010)

Objectives of this Lecture
Termination of Pregnancy: Ethical and Practical Consideration Tam, Wing Hung Associate Professor Department of Obstetrics & Gynaecology CUHK

1. Importance of pre‐conceptional counselling for patients with cardiac disease 2. Conditions for TOP 3. Legal aspect of TOP 4. Methods of TOP 5. Risk of TOP: specific to cardiac patient 6. An example of cardiomyopathy

Physiological Changes
• Increase in the intravascular volume • Increase in cardiac output • Lowering in the systemic BP • • • • •

In case of Pregnancy Complications:
Antepartum hemorrhage Preterm labour Pre‐eclampsia Blood loss at delivery Postpartum hemorrhage

Cardiac Conditions
• High risk of maternal mortality:
Eisenmenger’s syndrome Severe pulmonary hypertension Cardiomyopathy Marfan syndrome (aortic root dilatation > 4 cm)

Pre‐conceptional Counselling
• All women with significant cardiac disease at  reproductive age • Assess the risk of undergoing pregnancy • Discuss on the suitable choice of  contraception

MSc in Cardiology 2010-2011-CVSM 5001 Basic Cardiology (28 Dec 2010)

Termination of Pregnancy
• Abortion • Induced abortion • Ends the life of an unborn fetus • Ethical, legal & medical issues involved

• Balance between the life of the unborn fetus  and the risk of the mother if she goes through  pregnancy and delivery

Legal Aspect
• Carried out in a hospital or clinic maintained  by the Government or in an approved hospital  or clinic, unless to save the life of the pregnant woman; or  to prevent grave permanent injury to the physical  or mental health of the pregnant woman 

• 2 registered medical practitioners are of the  opinion, formed in good faith, that TOP is  necessary because ….

If Continuation of Pregnancy …
• would involve risk to the life of the pregnant  woman > if the pregnancy were terminated • would involve risk of injury to the physical or  mental health of the pregnant woman > if the  pregnancy were terminated • substantial risk that the child would suffer  from such physical or mental abnormality as  to be seriously handicapped

Also Applicable if:
• Child before attaining the age of 16 • Victim of incest, rape, drug rape, intercourse by  threats, or intercourse by false pretences & has  reported to the police within 3 months after the  date of such offences

MSc in Cardiology 2010-2011-CVSM 5001 Basic Cardiology (28 Dec 2010)

Termination of Pregnancy after 24 wk
• Only for saving life of the pregnant woman

Legal Procedures
• Carried out by registered medical  practitioners in gazetted hospitals or the  operating theatre of FPAHK • The operating medical practitioner is  responsible for completing Forms I & III not  later than 3 days after TOP to notify the  Director of Health

Methods of TOP
First‐trimester: • Medical method Mifepristone + PG  analogue Surgical method Vacuum aspiration Second trimester: • Medical method Mifepristone + PG analogue PG alone Intra‐amniotic hypertonic  saline, urea, PG Surgical method Dilatation and evacuation  (D&E) Hysterotomy Atard catheter Laminaria

1st Trimester: Vacuum Aspiration
• • • • • 7‐12 weeks gestation General or local (preferred) anaesthesia Safe if performed under strict aseptic technique by  trained personnel Pre‐operative cervical priming – enhance cervical  dilatation and minimise trauma Reducing infective complications: Prophylactic antibiotics or screen and treat for infections

1st Trimester: Vacuum Aspiration
• Cervical priming • Prostaglandins: e.g. misoprostol, gemeprost • Misoprostol – cheap, orally active, stable at  room temperature Acute  • • • • •

Operative Complications:  Vacuum Aspiration
Delayed • Failed abortion • Retained products • Pelvic  infection / endometritis • Cervical stenosis / incompetence Bleeding Cervical laceration Uterine perforation Vasovagal reaction

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