TOP

Data gathering

• Red flags – abdo pain, fever
• Others – LMP, consent, spoken to someone about this, alternatives (counselling, adoption), pressurised, DV
• Examine – BP, BMI, abdominal examination

Clinical management

• Investigations
  • Pregnancy test
  • Urine NAAT – chlamydia
  • Bloods – rhesus

• Explanation / Treatment
  • counselling – pregnancy advisory service
  • different types depending on how far the pregnancy is (usually woman’s choice)
  • Medical TOP –
    • up to 9 weeks – attend hospital on two separate days, given medications that block the pregnancy from continuing and that make your womb contract to cause the products of pregnancy to be expelled
  • Surgical TOP –
    • 7-15 weeks – suction tube to remove womb contents
    • > 15 weeks – dilatation and evacuation – neck of womb is dilated and contents expelled
  • Refer for TOP clinic

• Follow Up
  • post TOP counselling and contraception

• Safety Net
  • see dr if abdo pain, fever, or heavy PV bleeding (complications – infection, bleeding, injury)