Abortion

Question 1

Facts about abortion law

Answer 1

• Abortion has been a criminal offence in the UK since the nineteenth century but people can access an abortion if certain criteria are fulfilled in mainland UK - governed by the Human Fertilisation and Embryology Act 1990
• The effect of the 1967 abortion act provides certain legal defences to doctors who perform abortions
• Two doctors are required to allow a pregnancy to be terminated
• Limit of abortion is up to 24 weeks - know as ground C&D
• There is no time limit for women with a risk of death or serious permanent damage, or if there is a serious fetal abnormality - there are no specific criteria about what disabilities are serious enough
• Partners have no right of veto or even to be consulted
• The fetus has no legal right to life until after birth regardless of gestation
• Doctors have a legal and professional right to opt out of participating in abortion care
• It is unlawful to opt out of treatment for particular groups of patients
• Registered medical practitioners must notify the Chief Medical Officer of every abortion performed (7 days in Scotland, 14 days in England/Wales)
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Question 2

Abortion statistics

Answer 2

• 56 million induced annually
• 25% of all pregnancies end in abortion
• Global rate 35/1000 women of childbearing age
• Restrictive laws do not reduce numbers of abortions
• Unmet need for contraception increases the rate of abortions
• 1 in 9 women presenting for abortion had given birth within 12 months
• 1 in 4 parous women had given birth within the preceding 12 months
• 1 in 5 presenting for abortion had been pregnant in the last year
• Medical abortion up to 18 weeks
• Surgical procedures up to 13 weeks

Question 3

Types of abortion

Answer 3

• Medical
  
  • Early medical abortion at home
  • Inpatient
• Surgical (evacuation)
  
  • Local or general anaesthetic

Question 4

Medical abortion

Answer 4

• Mifeoristone (anti-progesterone, PO, can be discharge)
• Misoprostol (prostaglandin analogue, vaginal/buccal/sublingual, can be given for home - clinic for first dose, 16+ years, no significant comorbidities)
  
  • Abortion typically starts 2-3 hours after dose
  • Vaginal bleeding - heavy with clots
  • Lower abdominal pain
  • Most complete by 4 hours

Question 5

Surgical abortion

Answer 5

• Day-case procedure
• Fasted and adult escort for GA
• Can go to work the following day
• Abdominal pain and vaginal bleeding

Question 6

Other things to consider

Answer 6

• Contraceptive needs post abortion
• Anti-D IgG
• Cervical screening status
• Sexual health screen
• Gender based violence
• Possible long term psychological risk factors - offer counselling and ensure support

Question 7

Complications

Answer 7

• Failure to end the pregnancy
• Retained (non-viable) tissue
• Infection
• Haemorrhage
• Cervical tear
• Uterine perforation

Question 8

Contraindications

Answer 8

Question 9

When to seek medical attention post abortion

Answer 9

• Very heavy bleeding (soaking >2 pads for 2 consecutive hours, Sx of anaemia)
• Persistent bleeding or pain
• Offensive vaginal discharge
• High fever or systemically unwell