16. Termination of pregnancy Flashcards
gestation and termination of pregnancy
By law you can termination a pregnancy at any gestation under Grounds A, C, E, F, G
But very rare over 24 weeks (Ground C and D)
Viability – changed from 28 weeks when the law commenced
If under E and after 24 weeks usually perform fetocide first
UK stats
92% of abortions were carried out at under 13 weeks in 2014/2015/2016
81% were under 10 weeks in 2016; compared to 80% in 2014, 79% in 2013 and 68% in 2006
Grounds for abortion
180,794 (97%) carried out under Ground C (99.8% mental health)
1342 (1%) carried out under Ground D
3,208 abortions (2%) were carried out under ground E (risk that the child would be born handicapped)
246 under Ground A and B
6 cases under Ground F or G
By what age of gestation are most abortions performed?
10-12 weeks
Conscientious objection to participation in treatment
No person shall be under any duty to participate in any treatment authorised by this Act to which he has a conscientious objection, provided that in any legal proceedings the burden of proof of conscientious objection shall rest on the person claiming to rely on it
Nothing shall affect any duty to participate in treatment which is necessary to save the life or to prevent grave permanent injury to the physical or mental health of a pregnant woman
Doctors with a conscientious objection still need to the complete the paperwork including consent but not the legal form and care for the patient after the termination.
They have a duty to refer the patient to another doctor for the procedure.
Terminations
Free on NHS Carried out within a Licensed Clinic NHS clinic ( inpatient or out patient) BPAS Marie Stokes Brook ( under 25) Referral via GP/Family Planning Doctor (2 doctors to sign the abortion act form) Discussion re whether 2 doctors are required Post termination contraception Chlamydia screening
Surgical abortion
Usually under 12-14 weeks
Vacuum aspiration
GA or local anaesthesia
Over 14 weeks (rare)
Dilation and evacuation
Medical abortion
Progesterone antagonist (mifepristone) orally: stop the pregnancy
Combined with misoprostol (prostagladin E1 analogue) vaginally: start uterine contractions
Abortion occurs usually 2-6 hours after misoprostol
In UK legal restrictions on place of administration of these drugs: Under 9 weeks can take both tablets at home. Over 9 weeks the misoprostol is inserted in the clinic but still can go home
Risks with abortions
Mortality 0.6 deaths per 100,000 abortions (no deaths in 2014 but one in 2015 and one in 2016)
(cf 10 per 100,000 deaths in childbirth)
Failure: 0.2% after surgical & 0.7% after medical
Incomplete abortion (1%), excessive bleeding (0.1%), uterine damage (surgical) (0.5%), infection (<1%)
Long term sequelae
No association between abortion and: Ectopic pregnancy Infertility Placenta praevia Preterm birth Psychological effects
