How should I assess a patient's eligibility for a surgical termination of pregnancy?

To assess a patient's eligibility for a surgical termination of pregnancy, first confirm the gestational age, as surgical abortion is offered up to and including 23+6 weeks' gestation, with specific protocols depending on the gestation period ¹.

Evaluate for any contraindications or clinical appropriateness of surgical versus medical abortion methods, explaining options and reasons if surgical abortion is not suitable ¹.

Ensure the patient does not have signs or symptoms suggestive of ectopic pregnancy, especially if there is no definitive ultrasound evidence of an intrauterine pregnancy, as this affects eligibility and safety ¹,².

Consider cervical priming methods appropriate to the gestational age, such as osmotic dilators or misoprostol, with specific timing and combinations recommended to optimize safety and efficacy ¹.

Assess the patient's suitability for anaesthesia options, discussing local anaesthesia, conscious sedation, deep sedation, or general anaesthesia, tailored to patient preference and clinical factors ¹.

Offer antibiotic prophylaxis for surgical abortion to reduce infection risk, typically oral doxycycline 100 mg twice daily for 3 days, unless contraindicated ¹.

Evaluate thrombosis risk and consider pharmacological thromboprophylaxis with low-molecular-weight heparin if indicated, especially in high-risk patients ¹.

Incorporate patient preference and informed decision-making, using available decision aids to help choose between medical and surgical abortion methods ¹.

Recent literature supports that surgical abortion remains a cost-effective and clinically appropriate option in the first trimester, reinforcing guideline recommendations for patient-centred choice and safety (Barghazan et al., 2022).