Management options Termination for maternal indications

Termination of pregnancy is usually a day-case procedure, and routine preoperative assessment is undertaken immediately preoperatively. Assessment should be conducted sympathetically as these women are often very distressed.

Gestation is usually less than 15 weeks and these women can usually be regarded as non-pregnant with respect to gastric emptying and acid aspiration unless they have symptoms of reflux.

An anaesthetic technique suitable for day-case anaesthesia should be employed, e.g. induction with propofol followed by nitrous oxide/oxygen and maintenance with propofol or a volatile anaesthetic agent. There has been concern about concentrations of volatile anaesthetic agents greater than one minimum alveolar concentration causing uterine relaxation unresponsive to oxytocics. For a termination of pregnancy at less than 15 weeks, standard concentrations of volatile anaesthetic agents do not appear to pose a risk and may be used to maintain anaesthesia. Analgesia may be provided by intravenous fentanyl or alfentanil with rectal diclofenac 100 mg.

The gynaecologist may request that 5-10 U Syntocinon is administered to aid uterine contraction. There is no clear evidence that this is helpful at this stage of pregnancy.

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