Abortion Flashcards
Pre abortion act 1967
All abortion was a criminal act
Offences against the persons act 1861 section 58
Punishable by life imprisonment
Still applicable for abortion performed outside of legal provision
There were usually no doctors involved if they were they were working outside of the NHS
Terminology - abortion
Used in law - abortion act
Terminology- termination of pregnancy
Is used in the hospital scenario
Terminology - miscarriage
Naturally occurring
Terminology - post coital conception
Emergency contraception - not classed as an abortion as it is stopping a pregnancy from happening not aborting a pregnancy
How many doctors must agree that abortion can take place
2
What is section 1(1)a of the abortion act
Pregnancy has no exceeded 24 weeks and that the continuation of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of the family of the pregnant woman
Under 12 weeks always termination less risk
Not quantity of risk just risks - ding need to quantify
Can’t afford another child
Section 1b criteria
The termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
- woman has liver failure and if continues with the pregnancy she is likely need a transplant
Not transcient
No time limit
Section 1c
The continuation of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated - death due to preeclampsia
Death is likely
No time limit
Section 1d
There is substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped
No time limit
Section 1d how is the seriousness of the handicap assessed
It is up to the opinion of the clinician and for the woman what is serious to her
Which form needs to be filled out and within how many days dies it need to be sent to the chief medical officer
HSA4
14 days
Form split up differently
Ground A on the form is what ground in the abortion act
1 c
Risk to life greater than if terminated
Ground B permanent physical injury is what in the abortion act
1b
Ground C on the abortion act
Not exceeded 24 weeks risk greater than is terminated
Section 1a
Ground D - family existing children
1a
Ground E on form risk to child
1 d.
ground F and G on the form
Emergency treatment
Selective termination
Multiple foetuses reduce the number
Vast majority of termination happen when
Before 3 months
Feticide
Termination not be a live baby
Kill fetus before before termination
KCl Either into skull or heart
Only 4% don’t have feticide after 22 weeks
Down syndrome termination - challenge.
Huge spectrum of presentation - don’t know how handicapped they will be
How many diagnoses of Down syndrome come to birth
8%
Cleft palate - 30 termination
Can be fixed
Feticide - live births
Born alive - minute and 4 and a half hours
Left to die
Why chose have a termination - can be separated into trimesters
First trimester - panic, fear of someone finding out, contraceptive failure, inability to care for the child, pregnancy resulted from rapper or assault, social factors
Second trimester - prolonged consideration of choices, relationship changes, awaiting feral screening
Third trimester - fetal handicap, don’t need termination to sort blood pressure out you can have early delivery
Conscientious objection - only legally allowed for abortion
Under section 4 no duty to participate in any treatment
Must refer to another doctor
Exceptions are 1b and 1c must participate to prevent grave permanent injury to the physical or mental health of the mother or prevent maternal death
Who does conscientious objection apply to
Not midwives or nurses
On,h applies to someone carrying or ordering it not assisting
Case janaway v Salford AHA 1988
Dismissed her to court lost the case essential cog but not entitled to claim conscientious objection
Royal college of obs and gynae worried
Lack of speciality trainees because of the termination role, can conscientiously objecting so they don’t have enough staff willing to do it
GP don’t refer leaflet tells you to go to an abortion provider so many GPS conscientiously objecting
NHS funds
Dinner party tests - can’t tell them what you do - no one wants to admit they do the abortion
