Termination of Motherhood

 Termination of Pregnancy Composition

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 six. 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 Guidance

• All women with significant cardiac disease at� reproductive age • Assess the risk of undergoing pregnancy • Discuss on the suitable choice of� contraceptive

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

Considerations

• 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 December 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

initial 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

Late • Failed abortion • Retained products • Pelvic  infection / endometritis • Cervical stenosis / incompetence Bleeding Cervical laceration Uterine perforation Vasovagal response

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