Year: 2026
Type: conference-abstract
Abstract: Introduction Termination of pregnancy (TOP) is essential healthcare. This project evaluated outcomes in a district general hospital (DGH) TOP clinic against NICE and Royal College of Obstetricians and Gynaecologists (RCOG) standards, with focus on ectopic pregnancy detection (to assess the rationale for routine transvaginal ultrasound), contraception provision, and sexually transmitted infection (STI) testing. Methods We retrospectively reviewed all TOP clinic attendances from January–December 2024. Electronic records were audited using a proforma. Findings were compared with NICE/RCOG guidance and fed back to the team. Quality improvement (QI) interventions included targeted teaching and email prompts to staff. Results Among 285 patients, 1% had ectopic pregnancies. Care pathways were: 62% medical TOP, 14% surgical TOP, 3% manual vacuum aspiration, 3% miscarriage, and 6% continued pregnancy. Timeliness fell short of best practice: 47% were seen within one week of referral, and 65% were treated within one week of first appointment. STI screening for chlamydia/gonorrhoea was offered to all, no patients were offered HIV testing. Contraception was initiated in 56% of patients, with longacting reversible contraception (LARC) comprising 34% of methods. Conclusion Termination methods mirrored national patterns, but access targets were frequently missed due to capacity and preference-related delays. HIV testing was not offered, citing staff uncertainty about test management, indicating a clear training gap. Contraception provision was inconsistent, with suboptimal LARC uptake. The 1% ectopic rate underscores the safety of ultrasound; however, current NICE/RCOG guidance advises ultrasound only when gestation is uncertain or ectopic symptoms are present. Balancing guideline adherence with local risk and service capacity is warranted. Planned reaudit will assess the impact of QI measures and should prioritise improving booking capacity, implementing optout HIV testing with defined GUM referral pathways, standardising sameday LARC provision, and refining ultrasound protocols.
Authors: Jenna Blackaby, Lakshmi Sandu Aana
Institution: Mersey Care NHS Trust
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7214768241