Termination of pregnancy (Guidelines)

Patients can self-refer by contacting 01463 705667 and choosing option 2.

Those under 16 years of age can consent for the procedure as long as there is no element of coercion suspected. We do however, encourage them to involve an adult, even if not their parents.

The upper limit for termination of pregnancy (TOP) locally is 20 weeks. We are happy to see and assess women over 20 weeks, but they will be referred on to BPAS (British Pregnancy Advisory Service) for a termination up to 24 weeks. This would usually take place in London and currently involves a surgical procedure under general anaesthetic.

A link to a patient information leaflet will be sent by text after self-referral. The first appointment is a telephone appointment with a specialist nurse, on either a Monday or Tuesday. Where a face-to-face appointment is required, these take place on a Wednesday morning. We aim to see patients as soon as possible but the waiting time between referral and first appointment is very variable as we are a small team and we have fixed sessions.

What happens at the telephone appointment:

• The patient must be in a private place for their telephone conversation, in order to speak freely
• The appointment takes between 30 and 45 minutes
• The nurse will attempt to phone three times. If there is still no answer, the patient will be marked as “did not attend” and discharged. They would need to self-refer again for a new appointment if required.
• Medical history discussed
• Discussion of options including continuing with pregnancy, adoption and TOP
• Supporting patient choice is important
• Medical TOP offered until 20 weeks locally
• Early medical abortion at home (EMAH) is offered to those fulfilling the criteria and under 10 weeks’ gestation
• Surgical TOP possible between 7 - 12 weeks
• A surgical procedure under local anaesthetic (MVA) is not currently routinely available at Raigmore
• Treatment will be arranged within a week of consultation for the majority.
• Sexually transmitted infection (STI) screening will be offered/ arranged
• Contraception will be discussed and arranged. Patients are referred onwards to Highland Sexual Health for coils. For female sterilisation, patients will be referred to gynaecology (this cannot be done at the same time as the TOP procedure). For male sterilisation, the male partner will be advised to see their GP.
• In the following circumstances they will be referred to the face-to-face clinic for an ultrasound scan in order to establish gestational age and rule out early pregnancy complication:
  
  • Unsure of last menstrual period or irregular periods
  • Conceived on hormonal contraception or coil
  • Symptoms suspicious of early pregnancy complication (pain or bleeding)
  • Previously had an ectopic or twin pregnancy
  • Possibly more than 12 weeks’ pregnant
  • Recently postnatal (less than 6 months)

What happens at the face-to-face appointment:

• Information on what to expect will be given at the telephone appointment
• Patients can bring someone with them for support, but we will also need to see them on their own at one point for safe-guarding purposes

The risk of venous thromboembolim is increased in pregnancy from the first trimester and therefore patients who are at high risk of VTE should be started on thromboprophyalxis as soon as possible after a positive pregnancy test (as per RCOG Reducing the Risk of Thrombosis and Embolism during Pregnancy and the Puerperium (Green-top Guideline No. 37a)).

They will be advised by the clinic team when to withhold clexane for their treatment (usually at least 12 hours prior to taking mifepristone or at least 12 hours prior to admission for surgical termination).

BPAS: British Pregnancy Advisory Service
EMAH: Early Medical Abortion at Home
MVA: Manual Vacuum Aspiration
RCOG: Royal College of Obstetricians and Gynaecologists
STI: Sexually Transmitted Infection
TOP: Termination of Pregnancy
VTE: Venous Thromboembolism