Rosemary Cochrane

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    Management of first trimester termination of pregnancy as an out-patient in Paisley – is it feasible, is it acceptable and is it worthwhile?

    Rosemary Cochrane (Great Britain)

    Crawford JH – Department of Obstetrics and Gynaecology, Royal Alexandra Hospital, Paisley, UK

    Introduction. The earlier in pregnancy an abortion is performed, the lower the rate of complication. The RCOG recommends that ideally all women requesting pregnancy termination should undergo the procedure within 7 days of the decision to proceed being agreed. As a minimum standard, all women should undergo the procedure within 2 weeks of agreement, with no woman waiting longer than 3 weeks between initial referral to time of procedure. Medical termination of 1st trimester pregnancy (MTOP) has been shown to be effective, safe and acceptable if carried out on an entirely out-patient basis. It has therefore been suggested that a service to allow “home” MTOP might be beneficial, however patients would have to fulfil several strict criteria.

    Method. To ascertain eligibility every patient attending the pregnancy termination assessment clinic was asked to complete a confidential questionnaire.

    Results. 65 women completed the questionnaire (71% of those who attended). Of the 33 (51%) women opting for MTOP only 7 were eligible. 32 (49%) opted for a surgical TOP; of these, 12 would have considered a home MTOP if available but only 4 women were eligible. Reasons for ineligibility are discussed.

    Conclusion. Overall 11 (16.9%) patients requesting TOP would have fitted the criteria if the service was available. On the basis of this small sample we were unable to demonstrate a significant need for a home MTOP service.

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    Termination of pregnancy in Lothian: a health
    needs assessment
    Cochrane, R; Milne, D; Cameron, S
    NHS Lothian, UK
    Introduction: The rate of termination of pregnancy (TOP) in
    Scotland remains high, with 12 681 TOPs performed in Scotland
    in 2010.
    Most TOPs are hospital procedures or early medical
    termination. In 2011 a new centre for SRH (Chalmers) opened in
    Edinburgh; most provision of early medical termination will be
    delivered from here in the future. Some TOPs will continue to be
    performed within hospitals.
    Whilst much research has concentrated on the efficacy and
    acceptability of TOP, little has been written about women’s
    experience and the patient pathway.
    How the current service is viewed by users and providers, and
    the impact of future change to the service, was uncertain.
    This health needs assessment aims to:
    (i) describe population accessing TOP services in Lothian
    (ii) describe current service
    (iii) identify areas of delay in service provision
    (iv) identify areas of unnecessary complexity in patient’s
    journey
    (v) elicit stakeholders views
    (vi) consider evidence of and recommend effective intervention
    to improve termination services
    (vii) support planning for change from 2011.
    Methods: Women attending TOP services were interviewed and
    then telephoned approximately two weeks after TOP and
    questioned about their views of the TOP service.
    Staff members within the TOP service including management
    were interviewed.
    Results and conclusions: Seventeen women and 17 staff members
    were interviewed. Difficulty with patient recruitment and follow-
    up is discussed.
    Patients overall were happy with the service; several pertinent
    negative points were raised.
    Staff have mixed feelings about the service, and useful ideas for
    improvement were garnered, and form part of an action plan as
    part of the Lothian Sexual Health and HIV Strategy.