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Important: please update your RDS app to version 4.7.3 Details with newsletter below.

Please update your RDS app to v4.7.3

We asked you in January to update to v4.7.2.  After the deployment planned for 27th February, this new update will be needed to ensure that you are able to download RDS toolkits even when the RDS website is not available. We will wait until as many users as possible have downloaded the new version before switching off the old system for app downloads and moving entirely to the new approach.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. 

To update to the latest release:

 On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Right Decision Service newsletter: February 2025

Welcome to the February 2025 update from the RDS team

1.     Next release of RDS

 

A new release of RDS is planned (subject to outcomes of current testing) for week beginning 24th February. This will deliver:

 

  • Fixes to mitigate the recurring glitches with the RDS admin area and the occasional brief user interface outages which have arisen following implementation of the new distributed technology infrastructure in December 2024.

 

  • Capability to embed content from Google calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream into RDS pages.

 

  • Capability to include simple multiplication in RDS calculators.

 

The release will also incorporate a number of small fixes, including:

  • Exporting of form within Medicines Sick Day Guidance in polypharmacy toolkit
  • Links to redundant content appearing in search in some RDS toolkits
  • Inclusion of accordion headers alongside accordion text in search result snippets.
  • Feedback form on mobile app.
  • Internal links on mobile app version of benzo tapering tool

 

We will let you know when the date and time for the new release are confirmed.

 

2.     New RDS developments

There is now the capability to publish toolkits on the web with left hand side navigation rather than tiles on the homepage. To use this feature, turn on the “Toggle navigation panel” option at the top of the Page settings menu at toolkit homepage level – see below. Please note that publication to downloadable mobile app for this type of navigation is still under development.

The Benzodiazepine tapering tool (https://rightdecisions.scot.nhs.uk/benzotapering) is now available as part of the RDS toolkit for the national benzodiazepine prescribing guidance developed by the Scottish Government Effective Prescribing team. The tool uses this national guidance developed with a wide-ranging multidisciplinary group. This should be used in combination with professional judgement and an understanding of the needs of the individual patient.

3.     Archiving and version control and new RDS Search and Browse interface

Due to the intensive work Tactuum has had to undertake on the new technology infrastructure has pushed back the delivery dates again and some new requirements have come out of the recent user acceptance testing. It now looks likely to be an April release for the search and browse interface. The archiving and version control functionality may be released earlier. We’ll keep you posted.

4.     Statistics

At the end of January, Olivia completed the generation of the latest set of usage statistics for all RDS toolkits. If you would like a copy of the stats for your toolkit, please contact Olivia.graham@nhs.scot .

 

5.     Review of content past its review date

We have now generated reports of all RDS toolkit content that has exceeded its review date by 6 months or more. We will be in touch later this month with toolkit owners and editors to agree the plan for updating or withdrawing out of date content.

 

6.     Toolkits in development

Some important toolkits in development by the RDS team include:

  • National CVD prevention pathways – due for release end of March 2025.
  • National respiratory pathways, optimal cancer diagnostic pathways and cancer prehabilitation pathways from the Centre for Sustainable Delivery. We will shortly start work on the national cancer referral pathways, first version due for release via RDS around end of June 2025.
  • HIS Quality of Care Review toolkit – currently in final stages of quality assurance.

 

The RDS team and other information scientists in HIS have also been producing evidence summaries for the Scottish Government Realistic Medicine team, to inform development of national guidance around Procedures of Limited Clinical Value. This guidance will in due course be translated into an RDS toolkit.

 

7. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

  • Friday 28th February 12-1 pm
  • Tuesday 11th March 4-5 pm

 

To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)

 

To invite colleagues to sign up to receive this newsletter, please signpost them to the registration form  - also available in End-user and Provider sections of the RDS Learning and Support area.   If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot  If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.

With kind regards

 

Right Decision Service team

Healthcare Improvement Scotland

 

 

Medical Termination of Pregnancy Protocol (513)

Please report any inaccuracies or issues with this guideline using our online form

< 10 + 0 WEEKS GESTATION

Mifepristone Day

  • Ensure case-notes and appropriate documentation available.
  • Check consent form is signed
  • Check certificate A has 2 signatures.
  • Ensure confirmed intra-uterine pregnancy.
  • Complete paperwork in ICP/electronic record
  • Check the patient is sure of their decision.
  • Administer mifepristone 200mg PO in accordance with drug kardex. Patient may go home thereafter.
  • Advise patient to return to the place of administration if she vomits within 1 hour.
  • Ensure advice is given to the patient regarding pain and/or bleeding she may experience over the following 24-48 hours.
  • Ensure the patient has the ward telephone number.
  • Advise the patient to bring appropriate clothing for admission.

Misoprostol Day
48 hours following mifepristone.

  • Nurse enquires about pain/bleeding/passage of products of conception.
  • Check BP, pulse and temperature.
  • Explain the procedure to the patient.
  • Patient is NOT routinely required to fast.
  • Confirm contraceptive plan, and prescribe/administer as indicated.
  • Misoprostol 800 micrograms PV.
  • Diclofenac 100mg PR as prophylactic analgesia unless contraindicated. (If contra-indicated cocodamol 30/500 PO).
  • Patient to use bed pan throughout procedure to aid identification of POC.
  • If products ARE passed, follow the discharge procedure.

If no POC passed within 6 hours:

  • If POC are not passed within 4 hours administer 400 micrograms of misoprostol sublingually.
  • If no POC passed within one hour, perform speculum examination to ensure POC are not in cervix/vagina.

If POC are not identified following a second dose of misoprostol or during vaginal examination:

  • If pain and bleeding are satisfactory, the patient should be discharged home. The patient should be offered either follow-up scan by appointment at Sandyford after 7-14 days or a pregnancy test after 21 days. If the patient chooses the latter option, the pregnancy test kit should be supplied to the patient on discharge. If she chooses the scan option, then Sandyford contact details should be given so that she can make an appointment.
  • For patients who are <10 + 0 weeks gestation and pass what is thought to be incomplete POC – follow up is scan is NOT required. Advise the patient that bleeding is to be expected, however ensure ward contact details are given so that the patient can contact staff should they be concerned that their bleeding is heavier than anticipated.  

If excessive bleeding occurs before/after POC passed:

  • Perform speculum examination to evacuate clot and remove any POC identified.
  • If bleeding continues contact middle grade or consultant gynaecologist.
  • Fast patient.
  • Site venflon.
  • Check P/BP/T/O2 saturation every 15 minutes/high-flow facial O2 if bleeding continues.
  • Send FBC.
  • Cross-match and check clotting screen if signs of shock.
  • Give misoprostol 400 micrograms sublingually.
  • Give ergometrine 500 micrograms IM unless contra-indicated for the patient. This can be given at the same time as misoprostol, as it will be effective before the misoprostol has its maximum effect.
  • If bleeding persists or there are clinical signs of shock (tachycardia, hypotension), an urgent surgical evacuation should be arranged by medical staff.

DISCHARGE PROCEDURE FOR ALL PATIENTS

  • Record the patient’s BP, pulse and temperature prior to discharge.
  • Contraception must be supplied or a contraceptive plan agreed.
  • Anti-D is NOT required for rhesus negative women.
  • All patients with a multiple pregnancy require a follow-up scan at Sandyford

Scan Post TOP

If scan shows RPOC < 3cm – advise patient to seek referral if increased PV bleeding, pain or offensive PV loss.

If scan shows RPOC > 3cm the patient should be offered surgical evacuation of uterus if clinically indicated i.e. excessive bleeding.

If the patient declines surgical evacuation she may be managed conservatively with anti-biotics (co-amoxiclav 375mg TID for 7 days). A further scan will be required after 7-10 days to ensure RPOC is decreasing in size.

If scan shows a continuing pregnancy the patient should be given the option of MTOP or STOP depending on their gestation.

Protocol for MTOP 10-18 weeks gestation

Mifepristone Day

  • Ensure case-notes and appropriate documentation available.
  • Check consent form is signed
  • Check certificate A has 2 signatures.
  • Ensure confirmed intra-uterine pregnancy.
  • Complete paperwork in the ICP/electronic record.
  • Check the patient is sure of their decision.
  • Administer mifepristone 200mg PO in accordance with drug kardex. Patient may go home thereafter.
  • Advise patient to return to the place of administration if they vomit within 1 hour.
  • Ensure advice is given to the patient regarding pain and/or bleeding they may experience over the following 24-48 hours.
  • Ensure the patient has the ward telephone number.
  • Advise the patient to bring appropriate clothing for admission.

Misoprostol Day
48 hours following mifepristone.

  • Nurse enquires about pain/bleeding/passage of products of conception.
  • Check BP, pulse and temperature.
  • Explain the procedure to the patient.
  • Patient is NOT routinely required to fast.
  • Confirm contraceptive plan, and prescribe/administer as indicated.
  • Administer Misoprostol 800 micrograms PV.
  • Diclofenac 100mg PR as prophylactic analgesia unless contraindicated. (If contra-indicated cocodamol 30/500 PO).
  • After 3 hours administer 400 micrograms of misoprostol sublingually and repeat at 3 hourly intervals until abortion occurs.
  • Analgesia and anti-emetics should be administered as required.
  • Patient to use bedpan throughout procedure to aid identification of POC.
  • Following the delivery of foetus either with or without the placenta, syntometrine (ergometrine 500 micrograms with oxytocin 5 units) 1ml IM should be administered.
  • If the placenta is not passed within the hour of syntometrine being administered, the patient should be examined vaginally and placenta retrieved if possible.
  • If the placenta is not retrieved, site venflon, fast patient, and arrange theatre. Check FBC/coagulation screen if heavy bleeding.
  • Whilst awaiting theatre, administer misoprostol 400 micrograms sublingually. This should be repeated after a further 3 hours if still awaiting theatre.
  • Heavy PV bleeding following passage of placenta requires medical review to assess need for surgical evacuation of uterus. See “management of excessive bleeding” in <10 + 0 week section of guideline above.

Failure to Abort After 24 hours of Misoprostol 10 - 13 + 0 weeks

Surgical evacuation should be offered to patient.
If surgery declined/contraindicated follow guidance below.

Failure to Abort After 24 hours of Misoprostol > 13 + 0 weeks

  • Continue to give misoprostol 400 micrograms sublingually
  • 4 hourly BP/P/T. Commence NEWS chart.
  • PV assessment should be carried out by experienced medical staff 24 hours from commencing misoprostol.
  • If abortion has not occurred after 48 hours of misoprostol, further management must be discussed with a consultant gynaecologist.
  • Management will depend on the condition of the individual patient, pyrexia and gestation.
  • Ultrasound scan should be performed to exclude abdominal pregnancy/uterine rupture.
  • Consider day 3 of misoprostol if membranes intact.

DISCHARGE PROCEDURE FOR ALL PATIENTS

  • Record the patient’s BP, pulse and temperature prior to discharge.
  • Contraception must be supplied or a contraceptive plan agreed.
  • Anti-D prophylaxis MUST be given to ALL rhesus negative women over 10 weeks.
  • All patients with a multiple pregnancy require a follow-up scan at Sandyford

Editorial Information

Last reviewed: 01/12/2020

Next review date: 31/12/2025

Author(s): Nikki Harvey.

Version: 4 (Revised December 2020)

Approved By: Gynaecology Clinical Governance Group

Document Id: 513