1. Medical Termination of Pregnancy (MTOP) in WGH – The Re-audit
Dr Gayatri Ranjan (Associate Specialist)
Sarah Horseley (CNS Pregnancy Loss)
Mattie Thomas (Gynae Services Co-ordinator)
CEAD Hywel Dda NHS Trust 2009

2. CEAD Hywel Dda NHS Trust 2009
Background
Once weekly dedicated clinic.
Counselled , scanned and dates for TOP arranged.
Up to 12 wks and up to 2 terminations.
Mifepristone 200mgm PO , followed by misoprostol 800 microgram after hrs ,3 doses.
Follow up (2-3/52)
CEAD Hywel Dda NHS Trust 2009

3. CEAD Hywel Dda NHS Trust 2009
Aims
To assess whether we are maintaining the published high standard of care
To assess whether recommendations are fulfilled from previous audit
Assess the level of patient satisfaction
CEAD Hywel Dda NHS Trust 2009

4. CEAD Hywel Dda NHS Trust 2009
Method
Retrospective case note study:
1st January – 31st December 2008
GP referral letter
Proforma
Patient questionnaire to assess patient satisfaction
CEAD Hywel Dda NHS Trust 2009

5. CEAD Hywel Dda NHS Trust 2009
Standard for Audit
Royal College of Obstetricians & Gynaecologists Guideline: Care of women requesting induced abortion
Local Hospital Guidelines
CEAD Hywel Dda NHS Trust 2009

6. CEAD Hywel Dda NHS Trust 2009
Results
CEAD Hywel Dda NHS Trust 2009

7. Total number of patients who attended the unit = 366
CEAD Hywel Dda NHS Trust 2009

8. Of the 366 patient’s who attended the unit:
CEAD Hywel Dda NHS Trust 2009

9. CEAD Hywel Dda NHS Trust 2009
Age
CEAD Hywel Dda NHS Trust 2009

10. GP referral to hospital appointment
CEAD Hywel Dda NHS Trust 2009

11. Hospital appointment to 1st visit (Mifepristone)
* 2 undecided, 1 some other appointment
CEAD Hywel Dda NHS Trust 2009

12. CEAD Hywel Dda NHS Trust 2009
Gestation
* 12+1 – 12+5
CEAD Hywel Dda NHS Trust 2009

13. CEAD Hywel Dda NHS Trust 2009
Blood Group
CEAD Hywel Dda NHS Trust 2009

14. CEAD Hywel Dda NHS Trust 2009
Counselling
35 (12.5%) patients received counselling
2 patients had phone contact
CEAD Hywel Dda NHS Trust 2009

15. Outcome (Misoprostol)
CEAD Hywel Dda NHS Trust 2009

16. Of the 42 patient’s with an outcome of incomplete:
Conservative Management
Misoprostol = 6
Misoprostol & Evac = 1
Evacuation = 5
CEAD Hywel Dda NHS Trust 2009

17. Of the 17 patient’s who did not pass any product:
Misoprostol = 1
Conservative Mx = 6
Surg. Evacuation = 1
Repeat MTOP with 600mg of mifepristone = 3
Repeat MTOP with 600mg (failed) – surgical Evac = 1
CEAD Hywel Dda NHS Trust 2009

18. CEAD Hywel Dda NHS Trust 2009
Overall Outcome
No intervention needed
Complete
231
SSPT –ve on f/u 13
No RPOC 9
Conservative Mx with small RPOC 18
Total
271 (93.2%)
Secondary intervention
Surgical Evacuation 9
Repeat MTOP 3
Misoprostol 7
Total
19 (6.5%)
DNA 1
CEAD Hywel Dda NHS Trust 2009

19. CEAD Hywel Dda NHS Trust 2009
Complications
Major complications = Nil
Other complications = 20 (6.9%)
Heavy bleeding requiring 3 units transfusion and evacuation = 1 (5%)
Increased temperature = 5 (25%)
Bleeding = 11 (55%)
Increased pain = 2 (10%)
Vomiting = 1 (5%)
CEAD Hywel Dda NHS Trust 2009

20. CEAD Hywel Dda NHS Trust 2009
Hospital Stay
17 (5.8%) patients stayed overnight:
● Bleeding = 9 (1 patient stayed two nights)
Social problem = 2 (Cardigan/Haverfordwest)
Epileptic = 1
Increased temperature = 1
Swollen abdomen = 1
Not passed product (4th dose) = 3
CEAD Hywel Dda NHS Trust 2009

21. CEAD Hywel Dda NHS Trust 2009
Histopathology
One patient diagnosed with Partial Molar pregnancy
CEAD Hywel Dda NHS Trust 2009

22. Comparison Of Results With 2003 Audit
CEAD Hywel Dda NHS Trust 2009

23. Total number of patients 2008 = 291 2003 = 288
CEAD Hywel Dda NHS Trust 2009

24. GP referral to Hospital appointment
CEAD Hywel Dda NHS Trust 2009

25. Hospital appointment to 1st visit (mifepristone)
CEAD Hywel Dda NHS Trust 2009

26. CEAD Hywel Dda NHS Trust 2009
Outcome
CEAD Hywel Dda NHS Trust 2009

27. Secondary Interventions
Overall Scores
Secondary Interventions
Surgical Evacuation
2008
6.5% (19 patients)
2.95% (9 patients)
2003
7.6% (22 patients)
6.2% (18 patients)
CEAD Hywel Dda NHS Trust 2009

28. Patient Satisfaction Questionnaire
Random questionnaire
November 2007 – April 2008
71 answered
CEAD Hywel Dda NHS Trust 2009

29. CEAD Hywel Dda NHS Trust 2009

30. Number of patients who answered the questionnaire = 71
CEAD Hywel Dda NHS Trust 2009

31. Comments/Suggestions
Excellent
Thanks
Compassionate
En-suite toilet
Rooms not comfortable (hot)
Something to entertain (TV/Radio)
Doctors to discharge early in the morning
CEAD Hywel Dda NHS Trust 2009

32. CEAD Hywel Dda NHS Trust 2009
Recommendations
Adherence to guidelines 
Patient’s to be cared for separately to other gynae patients 
Change of antibiotics policy 
Supply of contraception (first depot) 
MTOP leaflet 
Patient satisfaction survey 
Infection screening 
CEAD Hywel Dda NHS Trust 2009

33. CEAD Hywel Dda NHS Trust 2009

34. CEAD Hywel Dda NHS Trust 2009
Action Plan
Continue to maintain the high standard of care .
Infection screening.
Follow up (3 weeks for incomplete and 2 weeks for not passed anything).
CEAD Hywel Dda NHS Trust 2009

35. CEAD Hywel Dda NHS Trust 2009
Acknowledgements
Audit Department.
Staff of Gynae Suite.
Patients.
CEAD Hywel Dda NHS Trust 2009

36. CEAD Hywel Dda NHS Trust 2009
Thank You
CEAD Hywel Dda NHS Trust 2009