2474 RCOG Abortion Guideline - Abtreibung.at

115 Pages·2004·0.91 MB·English

G
Royal College of Obstetricians and Gynaecologists
Setting standards to improve women’s health
U
I
The Care of Women
D
Requesting Induced
E
Abortion
L
I
N
Evidence-based Clinical Guideline Number 7
E
September 2004

The Care of Women
Requesting Induced
Abortion
Evidence-based Clinical Guideline
Number 7
September 2004
Royal College of Obstetricians and Gynaecologists
Setting standards to improve women’s health
First published 2000
This revision published September 2004
© Royal College of Obstetricians and Gynaecologists 2004
ISBN 1-904752-06-3
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted
in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior
written permission of the Publisher (Royal College of Obstetricians and Gynaecologists). The RCOG consents
to the copying of this guideline for the purpose of producing local protocols/guidelines in the United
Kingdom, provided that RCOG is cited as the source.
The use of registered names, trademarks etc. in this publication does not imply, even in the absence of a
specific statement, that such names are exempt from the relevant laws and regulation and therefore free for
general use.
Product liability: the RCOG can give no guarantee for information about drug dosage and application thereof
contained in this guideline. In every individual case the respective user must check its accuracy by consulting
other pharmaceutical literature.`
Published by the RCOG Press
at the Royal College of Obstetricians and Gynaecologists
Registered Charity No. 213280
Copies of the Guideline Summary and a version for women and their families can be obtained from the
website at www.rcog.org.uk
All correspondence with regard to this guideline should be addressed to:
Clinical Governance and Standards Department
Royal College of Obstetricians and Gynaecologists
27 Sussex Place
Regent’s Park
London
NW1 4RG
Telephone: [phone]
Email: [email protected]
Website: www.rcog.org.uk
Design and setting by FiSH Books, London.
Printed by Manor Press, Unit 1, Priors Way, Maidenhead, Berks. SL6 2EL
Contents
Abbreviations v
Development of the guideline vii
Peer reviewers viii
Acknowledgements viii
1. Introduction and methodology 1
1.1 The guideline topic 1
1.2 Aim of the guideline 3
1.3 For whom is this guideline intended? 3
1.4 Local protocol development 4
1.5 Methods used in the development of this guideline 4
1.6 Implementation and review 6
2. Summary of recommendations 7
2.1 Organisation of services 7
2.2 Information for women 8
2.3 Pre-abortion management 9
2.4 Abortion procedures 10
2.5 Aftercare 13
3. Legal and ethical aspects of abortion 14
3.1 The Abortion Act 14
3.2 Good professional practice 16
3.3 Confidentiality 16
3.4 Professionals’rights: conscientious objection to abortion 16
3.5 Issues relating to consent to treatment 17
3.6 Abuse of children and vulnerable people 19
3.7 Rights of the spouse or partner 20
3.8 Disposal of fetal tissue 20
4. Organisation of services 22
4.1 Access and referral to abortion services 22
4.2 Waiting times in abortion services 23
4.3 Settings for abortion care 24
5. Information for women 28
6. Pre-abortion management 36
6.1 The abortion decision 36
6.2 Blood tests 37
The Care of Women Requesting Induced Abortion
6.3 Cervical cytology 38
6.4 Ultrasound scanning 39
6.5 Prevention of infective complications 40
6.6 Feticide prior to late abortions 43
7. Abortion procedures 44
7.1 Surgical methods of abortion 45
7.2 Medical methods of abortion 51
7.3 Analgesia for abortion care 56
7.4 Histopathology 57
8. Aftercare 59
8.1 Rhesus prophylaxis 59
8.2 Post-abortion information and follow-up 60
8.3 Contraception following abortion 60
9. Standards for audit and service accreditation 63
9.1 Organisation of services 63
9.2 Information for women 63
9.3 Pre-abortion management 63
9.4 Abortion procedures 63
9.5 Aftercare 64
Appendix: Evidence tables 65
1 Relative safety of abortion at increasing gestations 65
2 Rate of uterine perforation during termination of pregnancy 66
3 Incidence of cervical injury during first-trimester abortion by vacuum aspiration 66
4 Incidence of cervical injury during second-trimester abortion by dilatation and
evacuation in illustrative large case series 66
5 Induced abortion and subsequent breast cancer risk 67
6 Future reproductive outcomes 68
7 Induced abortion and subsequent mental health 69
8 Studies relating to local versus general anaesthesia 70
9 Studies comparing manual with electric vacuum aspiration 70
10 Cervical priming randomised controlled trials 71
11 Cervical priming prior to surgical abortion 74
12 Combined early medical abortion regimens 76
13 Comparisons of regimens used in first-trimester abortions 78
14 Studies comparing various agents used in second-trimester medical abortions 80
15 Use of oxytocic agents to reduce blood loss at the time of surgical abortion 86
References 87
Index 101
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Abbreviations
ACOG American College of Obstetricians and Gynecologists
(cid:2)hCG beta human chorionic gonadotrophin
BMA British Medical Association
bpas British Pregnancy Advisory Service
CEMD Confidential Enquiries into Maternal Deaths in the UK
CI confidence interval
CMO Chief Medical Officer
COC combined oral contraceptive
COG Clinical Outcomes group
D&C dilatation and curettage
D&E dilatation and evacuation
DARE Cochrane Library Database of Reviews of Effectiveness
DH Department of Health
DSH deliberate self harm
EP ectopic pregnancy
FFPRHC Faculty of Family Planning and Reproductive Health Care
FHPM Faculty of Public Health Medicine
FIGO International Federation of Gynecology and Obstetrics
fpa Family Planning Association
GMC General Medical Council
GP general practitioner
GUM genitourinary medicine
hCG human chorionic gonadotrophin
HFEA Human Fertilisation and Embryology Authority
HIV human immunodeficiency virus
HTA Health Technology Assessment
IUD intrauterine device
IUS intrauterine system
KCl potassium chloride
MDU Medical Defence Union
MVA manual vacuum aspiration
NCI National Cancer Institute
NCSC National Care Standards Commission
NHS National Health Service
NMC Nursing and Midwifery Council
NSAID nonsteroidal anti-inflammatory drug
OR odds ratio
OOR overall odds ratio
PCO primary care organisation
PID pelvic inflammatory disease
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The Care of Women Requesting Induced Abortion
POP progestogen-only pill
RCN Royal College of Nursing
RCOG Royal College of Obstetricians and Gynaecologists
RCT randomised controlled trial
Rh rhesus
RR relative risk
UKCC United Kingdom Central Council for Nursing, Midwifery and Health Visiting
VAS visual analogue scale
WHO World Health Organization
WHOMEC World Health Organization medical eligibility criteria
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Development of the
guideline
This guideline on abortion care was first developed in 2000 by a multi-professional working group
(referred to here as the Guideline Development Group). The group was convened by the Royal
College of Obstetricians and Gynaecologists (RCOG) and supported by funding awarded by the
Department of Health (DH). Members included nominees of the RCOG, the Faculty of Family
Planning and Reproductive Health Care (FFPRHC), the Royal College of General Practitioners, the
Faculty of Public Health, the British Pregnancy Advisory Service (bpas), a nurse counsellor and a
consumer representative nominated by the RCOG Consumers’ Forum. All members of the group
made formal declarations of interest at the outset and these were recorded. This record is kept on
file at the RCOG. The College was of the opinion that the interests declared did not conflict with
the guideline development process.
The development of this updated version of the guideline was led by Dr Gillian Penney FRCOG,
who chaired the Guideline Development Group and is Honorary Director of the Clinical
Effectiveness Unit of the FFPRHC. Funding was again provided by the Department of Health. The
development process incorporated a single meeting of an expert advisory group (referred to here as
the Guideline Update Group) in December 2003. The members were:
Dr Gillian Penney (Chair), Scottish Programme for Clinical Effectiveness in Reproductive Health,
RCOG nominee.
Dr Susan Brechin, FFPRHC Clinical Effectiveness Unit
Dr Ken Bidgood, RCOG nominee
Ms Ann Furedi, bpas, charitable sector representative
Mrs Susie Marwood, RCOG Consumers’Forum representative
Dr Kate Guthrie, FFPRHC nominee
Dr Sharon Hopkins, Faculty of Public Health Medicine nominee
Dr Hilary McDermott, Royal College of General Practitioners nominee
Ms Hazel McBain, Nurse Counsellor
Mr Sam Mirando, FFPRHC nominee
Mr Anthony Parsons, RCOG nominee
Dr Connie Smith, FFPRHC nominee
Dr Sam Rowlands, bpas, charitable sector representative
Dr Helen Ribbans, FFPRHC nominee
Mr Michael Bowen, Department of Health observer
Miss Gillian Stephen, Research Assistant
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The Care of Women Requesting Induced Abortion
The development of this updated guideline was supported by the RCOG Guidelines and Audit
Committee. The members were:
Miss MC Davies MRCOG (Chair)
Dr RAAnderson MRCOG
Ms T Belfield (Consumer’s Forum representative), Family Planning Association
Mrs C Dhillon, Head of Clinical Governance and Standards, RCOG
Miss K Duckitt MRCOG
Miss LMM Duley FRCOG
Professor NM Fisk FRCOG, Chairman of the RCOG Scientific Advisory Committee
Mr JM Jenkins FRCOG
Professor WL Ledger FRCOG
Dr G Lewis FRCOG, Department of Health
Dr MCM Macintosh MRCOG, Confidential Enquiries into Maternal and Child Health
Dr D Rajasingam MRCOG (Trainees’representative)
Ms W Riches, National Institute for Clinical Excellence observer
Mr IV Scott FRCOG
Mr MI Shafi MRCOG
Mr CR Stewart FRCOG, co-opted member
Miss JM Thomas MRCOG, National Collaborating Centre for Women’s and Children’s Health
Peer reviewers
Comments were received from the following individuals during the peer review stage. A summary
table of comments received and actions taken is available on request from the RCOG.
Sheila Adam
Vincent Argent
Lucy Caird
Kay Ellis
Kathy French
Sunanda Gupta
Lesz Lancucki
CJ McNicholas
Victoria Pickles
Acknowledgements
The Guideline Update Group and the Guidelines and Audit Committee would like to thank Gill
Roberts, Writer/Editor, RCOG Clinical Governance and Standards Department, and Elaine Garrett,
RCOG Reader Services Librarian, for their assistance with this revision.
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