Medical TOP
Overview
1 in 4 Australian women age 18 to 45 have had an unplanned pregnancy in the last 10 years
30% of unintended pregnancies end in termination
40% of pregnant people were using a form of contraception ath the time of pregnancy
64% COCP
27% Condoms
6% LARC
1% Diaphgram / ring
2% Withdrawal / Emergency contraception
Of the pregnant peopple not using contraceptive (Marie Stopes 2008)
36% had not been expecting sex
17% believed they weren’t fertile and wouldn’t become pregnant
80% of women didn’t seek emergency contraception
1 in 10% never felt comfortable asking their partner to wear a condom
High rates
Rural areas
Lower socioeconomic
Sexual coercion
Link with pregnancy + DV
Options
Parenting = 56%
Adoption = 2%
Abortion = 29%
Miscarriage = 13%
TOP
Medical
2 step process over 24 to 48 hours
At home < 9 weeks
In hospital > 9 weeks
Feticide if >16 weeks
Surgical
<14 weeks - suction curettage
>14 more complex with cervical ripening
Maximum of 19+6/40
After 20 weeks gestation the birth must be registered, baby names and funeral
Surgical
Single visit between 6 to 14 weeks
Can’t drive 24 hours and responsible adult at home for 14hrs
Bleeding and cramping but generally less than medical TOP
Can have IUD or inplanon
RTW the next day
More expensive
Medical TOP
Multiple visits
Done at home <9/40
Responsible adult at home
Less predictable
May see POC = Uncommon
May bleed 4 weeks
Needs follow up (urine, blood or U/S)
No IUD until TOP complete
RTW next day
Risks
Ongoing pregnancy with MTOP = 1-2%, STOP = 1 in 1000
Need for further intervention MTOP <14 = 70/1000, STOP = 35 in 1000
Pre-Appointment
Client age + Consent
Gestational age
Medical history, medications, and allergies
Current symptoms in PID
Date of last CST
Smoking, alcohol and recreational drug use
Psychosocial setting
U/S, bloods, STI screening
Access to hospital emergency department with 2 hours
Support person
Contraceptive options
Risks
Resources:
TOP - HNE PATHWAYS
MTOP + Counselling in GP - Brightwell