This short course is designed for doctors who want to be able to offer an induced fetal demise procedure (feticide) for people as a part of later abortion care. In Aotearoa New Zealand this procedure should be offered to people for medication and procedural abortions from 22 weeks gestation and can be offered as early as 15 weeks. The New Zealand College of Sexual and Reproductive Health (NZCSRH) recommends that later abortion providers in Aotearoa New Zealand should only offer feticide if:

• they are a RANZCOG fetal maternal medicine subspecialist or equivalent, OR
• they have been providing feticide and can provide evidence of clinical competency, OR
• they have received endorsement from the NZCSRH after:
  1. Acknowledging their understanding and agreement with the NZCSRH Position Statement, "Feticidal Injection Prior to Abortion"
  2. Completing the NZCSRH training module, Later Abortion Training: Feticide", and
  3. Demonstrating clinical competency.
     

Evidence of each requirement having been fulfilled must be submitted to NZCSRH for review, prior to the provider being issued an endorsement from NZCSRH to provide feticidal injections.

To complete the NZCSRH training module, "Later Abortion Training: Feticide", trainees are required to:

• provide evidence of advanced ultrasound skills,
• examine best international practice through a set of readings followed by a multichoice quiz, and
• attend a practical workshop.

Clinical competency to provide feticide can be achieved through one of two ways:

• trainees need to identify a mentor and audit their first 10 cases, with 5 consecutive fetal demises to define competency, OR
• trainees need to have sign off from a preceptor who has observed 3 competent procedures as outlined in the DOPS induced fetal demise assessment form.

The NZCSRH acknowledges that the provision of feticidal injection after 22 weeks' gestation is uncommon. In order for a practitioner to provide feticidal injection independently after 22 weeks' gestation, sign off must have been received from a preceptor; auditing outcomes with a mentor is not sufficient.

Feticide providers can be considered a mentor or preceptor if they are a RANZCOG fetal maternal medicine subspecialist, or after completing 20+ successful feticides and have been approved to the position by NZCSRH. The location where trainees work, and the clinical demand for the service, may determine whether using a mentor or preceptor is the more suitable option.

Learning objectives

• describe the techniques and equipment used to provide feticide in Aotearoa New Zealand
• apply these techniques in a workshop setting to gain practical experience
• reflect on and develop their learning through their involvement in an online forum and ongoing clinical experiences.