Top: From The thirtieth Week(12 weeks & 1 day) up to the twentieth week(19 weeks and 6 days)

O04.9

Medical TOP: From 12 weeks onwards, inpatient care in facilities with 24-hour service and facilities for general anaesthesia, as there is a greater risk for bleeding or a need for surgical completion of the procedure.

LoE:III [25]

Manual vacuum aspiration (up to 14 weeks). Misoprostol 400 mcg administered sublingually or vaginally, 2 to 3 hours prior to the procedure for cervical priming.

Surgical TOP (Dilatation and Evacuation procedure after cervical preparation) can be done by specially trained providers as a day theatre procedure after 14 weeks.

GENERAL MEASURES

Manual vacuum aspiration of the uterus, if expulsion of products of conception is not complete after medical termination.


MEDICINE TREATMENT for Medical TOP

  • Mifepristone, oral, 200 mg, oral, immediately as a single dose.

LoEI [26]

Follow 1-2 days later with:

  • Misoprostol, PV/SL/buccal, 400 mcg, every 3 hours until abortion occurs.

LoEII [27]

Analgesia:

  • Morphine, IM, 0.1 mg/kg 4 hourly as needed, to a maximum of 10 mg.

LoEIII [28]

If Rh-negative: O36.0

  • Anti-D immunoglobulin, IM, 100 mcg as a single dose.

Contraception:
Counsel all women on effective contraception, especially long-acting reversible methods.

All methods can be given at the time of the procedure, with the exception of the IUCD at a medical TOP.

REFERRAL

  • Complicating medical conditions, e.g. cardiac failure, etc.
  • Failed procedure.
  • Ectopic pregnancy.