Termination of pregnancy in South Tyneside

Abstract

We evaluated prospectively, compliance with the Royal College of Obstetricians and Gynaecologists (RCOG) guidelines on termination of pregnancy (TOP) in a cohort of 340 women referred for termination of pregnancy in 2003 at South Tyneside Foundation Trust. The number of referrals represented one-fifth of all births in our unit during the study period. Teenagers were the largest single group of women requesting termination of pregnancy and the majority were nulliparous. There were 85 women who were seeking a repeat termination of pregnancy. The RCOG minimum referral standard was met in 80% of cases. A good number of women were unsure of their menstrual dates and only 5% had used emergency contraception. A total of 96% were either not using contraception, using condoms or taking oral contraceptives irregularly. A total of 50% of the women attended hospital without a Certificate A being completed by the referring practitioner. Surgical termination was preferred over medical termination in the cohort of women who could exercise a choice. It is possible to comply with the RCOG Termination of Pregnancy guidelines to a large extent in a District General Hospital, with some innovation. Close liaison between General Practitioners, Family Planning Clinics and Acute Hospitals is required. The adoption of agreed referral requirements and pathways would help in the delivery of a high quality service as advocated by the guideline.

Towards comprehensive early abortion service delivery in high income countries: insights for improving universal access to abortion in Australia

“…Of these, six papers focus specifically on service delivery related to aspects of surgical termination of pregnancy (STOP) while nine papers were concerned with medical termination (MTOP). Other papers describe both types of abortion with service related outcomes according to the components of care [ 48 , 63 ], approach to service integration [ 45 ], referral, booking and counselling [ 43 , 44 , 49 , 56 , 67 ] and the type of facility where the services are provided [ 23 , 46 , 60 , 61 , 64 – 66 ]. Of the access dimensions covered, least covered were adequacy and affordability with supply focused papers gaining more attention than those solely concerned with demand side issues.…”

“…However, a review of clinic records in one area in the UK shows that about half of the patients were referred without a Certificate “A” being completed by the referring GP, the reasons for this in some cases was due to issues doctors had with abortion and their conscientious objection to TOP. It was suggested that this may impact upon the speed at which women are able to obtain and abortion [ 43 ]. Women in NZ who had more than one visit from their referring doctor also experienced a longer delay to receive an abortion than those who had a single visit [ 65 ].…”

“…Lack of integrated care was reported. (Esen et al 2006) [ 43 ] Medical and surgical abortion: TOP clinic South Tyneside Foundation Trust, England UK Quantitative descriptive: prospective survey and examination of case notes 340 women requesting termination of pregnancy seen at the clinic in 2003 To evaluate the termination of pregnancy service in South Tyneside including our compliance with Royal College of Obstetricians and Gynaecologists termination of pregnancy guidelines The number of referrals represented one-fifth of all births in our unit during the study period. Teenagers were the largest single group of women requesting termination of pregnancy and the majority were nulliparous.…”

Early medical abortion at home

“…It is certainly not an emergency situation and some independent time away from providers of the service is desirable. The Royal College of Obstetricians and Gynaecologists (RCOG)4 guidelines on abortion recommends the identification of patients who may require additional support in coming to a decision, providing such support or channelling patients towards such support which may not be available or cannot be provided at the assessment. The guideline considers the interval of between 72 hours and 1 week as an acceptable assessment-to-abortion interval.…”

“…It is possible to meet the RCOG4 guidelines for the provision of abortion services by cutting out undue delays. The place to do this is in the referral and appointments procedures, for example, by agreeing referral criteria with local general practitioners (GPs), giving telephone appointments to GPs and accepting faxed referrals rather than posted referrals and appointments 5.…”