Late Terminations of Pregnancy - are they a Safe bet?
ESC Congress Library. McConnell S. May 28, 2014; 50425; A-007
Dr. Sarah McConnell
Dr. Sarah McConnell
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Abstract
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OBJECTIVES


To evaluate the outcomes of late terminations of pregnancy carried out by an established NHS service over two years in terms of evidence-based practice guidelines as set out by RCOG.


DESIGN AND METHODS


We evaluated sixty-four women referred to the service for terminations from 18-24 weeks gestation.
Their demographics, contraception and obstetric history were analysed alongside their waiting time to procedure, procedure type, outcomes and contraception needs. We used an anonymised database from the service as well as electronic patient records and paper notes where required.

RESULTS


81.5% of referred patients went on to have terminations. Their average age was 28 and average gestation was 20.3 weeks. 11.5% of these were indicated for fetal anomaly. 85% were unplanned pregnancy of which more than half were due to unprotected sexual intercourse.
Of the 64 patients, 63.5% opted medical and the remaining opted surgical method for termination.
More than 90% of patients had their procedure within 10 days of being referred. Of the five patients that waited longer, one was due to a failed early medical procedure. The other four patients delayed their procedure for personal reasons.
Post late medical termination, six patients required an ERPC due to retained placenta or heavy bleeding.
Following the procedures, 41.8% of patients accepted LARCs which were inserted either at the time of the procedure or within two weeks.

CONCLUSIONS


The results show overall safety of late terminations of pregnancy, with low rates of morbidity.
In our group the number of terminations carried out for fetal anomaly make up a more significant number than fetal anomaly terminations over all gestations, not surprising for second trimester abortions following antenatal screening. These must be carried out sensitively, with clear signposting or access to specialist counselling available throughout. Counselors are essential in any abortion care service, especially when considering late terminations.
Given that our results show a higher second intervention rate for late medical termination than the 5% quoted by RCOG \"for all gestations\", thoroughly informing patients about risks of failure and complications is essential, even in an experienced and skilled unit.
Over 85% of these pregnancies were due to condom accidents or unprotected sexual intercourse. There was a strong uptake of both LARCs (54.5%) and combined or progesterone-only pills (25.5%) in these patients, showing the importance of easily accessed contraception and staff trained to provide it.


 

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