Abortion

Question 1

Which term is more appropriate for clinical practice and why?

Answer 1

Termination of pregnancy - Neutral, factual, less emotional

Question 2

What two types of termination are not included in abortion statistics?

Answer 2

Miscarriage / spontaneous termination

Post coital contraception - no implantation occurs so not abortion

Question 3

What was the law before the abortion act?

Answer 3

All abortion was a criminal act for the person requesting and person carrying out the procedure. Punishable by life imprisonment.

Question 4

When might a person be imprisoned for abortion now?

Answer 4

If the abortion is performed outside of legal provision.

Question 5

What is the current Abortion Act 1967?

Answer 5

Allows an abortion in accordance to the act within 24 weeks gestation with the approval of 2 Drs that notify the CMO within 14 days via HSA4 form.

Question 6

On what grounds can an abortion take place under section 1(a)?

Answer 6

If the pregnancy is less than 24 weeks and it is considered to involve higher risk to physical or mental health of the woman or existing children, than a termination.
Upto 12 weeks, any pregnancy is always more dangerous than a termination so is supported by the law before this gestation.

Question 7

Give an example of why a woman may be allowed a termination under section 1(1)a.

Answer 7

Family is not financially stable enough for another child.
Fear of someone finding out
Contraceptive failure
Rape/incest
Social factors
Liberal approach to respect opinions and behaviours.

Question 8

On what grounds can an abortion take place under section 1(1)b?

Answer 8

A termination is necessary to prevent grave permanent injury to physical or mental health of the pregnant woman, leaving the woman with a poor health outcome after the pregnancy. Allows termination upto 40 weeks.

Question 9

On what grounds can an abortion take place under section 1(1)c?

Answer 9

The continuation of pregnancy involves risk to life of the women that is greater than if terminated - there is a chance of death e.g. eclampsia
Allows termination upto 40 weeks.

Question 10

On what grounds can an abortion take place under section 1(1)d?

Answer 10

A substantial risk that if the child was born they would suffer from a physical or mental abnormality that would results in serious handicapped abilities. Allows termination upto 40 weeks.
It is down to the Dr and Mother to determine what they feel is classed as seriously handicapped.
Screening may delay the decision and so no limit is put on the termination.

Question 11

What is requested on a HSA4 form?

Answer 11

ethincity, martial status, method of termination, number of previous pregnancies. Used for data purposes.
State the grounds and section under which the termination is acceptable (may be more than one). Emergency termination to save mother’s life has a different section.

Question 12

How many pregnancies end in termination in England and Wales?

Answer 12

1 in 4 but this is rising, with more occurring at earlier gestations of 12-14wks.

Question 13

What is happening to the trends of the health care sectors used for termination?

Answer 13

The use of the private and NHS sectors are falling. The NHS funded independent sector is rising, with the NHS paying for it to be carried out on other premises.

Question 14

Why is the NHS carrying out less abortions?

Answer 14

More staff are conscientiously objecting

Question 15

How is a termination carried out?

Answer 15

For gestations >22 weeks, the life is ended before termination to prevent live birth. CaCl is injected into the fetal skull or heart for feticide. The stress of the procedure may cause too much stress and stop the fetal heart first.
Medical procedures are increasing and surgical falling as more being done at early gestations.

Question 16

Which section applies to the termination of a fetus with a high risk of Down’s syndrome?

Answer 16

1(1)d - 92% of women terminate when informed of Down’s risk. It can present in various ways so it is unknown if severe defects will present.

Question 17

Which section applies to the termination of a fetus with cleft lip and palate?

Answer 17

1(1)d - The rate is falling as fundraising is allowing surgeons to repair the defect quickly for a low cost.

Question 18

From which countries in particular do women come to England for a termination?

Answer 18

Islamic and Catholic countries

Question 19

What advice must be given to a woman during counselling for the termination?

Answer 19

Contraceptive advice

Question 20

What happens if a baby is born live during a termination due to failure of feticide?

Answer 20

The baby is given drugs to make them drousy and to prevent crying but are then left to suffer and die. Cannot care for the baby as the mother did not consent to a live birth.

Question 21

What alternatives may be possible for a woman requesting a termination under section 1(1)b and 1(1)c?

Answer 21

Early delivery

Question 22

Who can conscientiously object to a termination?

Answer 22

Under section 4 there is no duty to participate in any treatment but must refer to another Dr. However in situations applying to 1(1) b and c when the mother’s life is at risk, the pt must be their priority. Objection only applies to anyone who would PERFORM the procedure.

Question 23

Who cannot conscientiously object?

Answer 23

Nurses and midwives and receptionists writing the referrals.

Question 24

Why is the recruitment of OBGYNs becoming increasingly difficult?

Answer 24

Stigma associated with the role from the public - ‘dinner party test’.
Data driven due to the increasing numbers of abortions.

Question 25

What is the role of a GP in the termination process?

Answer 25

GP can refer a woman or they can simply provide them with leaflets advising them where to go.