Ethics at the beginning of life Flashcards
What does ToP stand for?
Termination of pregnancy
What country has a different abortion legislation from Great Britain?
Northern Ireland
What 2 categories can the clinical aspects of termination be divided into?
Less than 14 weeks and 14 weeks or more
What are the surgical and medical options from ToP in those less than 14 weeks pregnant ?
Surgical;
- Manual or electric vacuum aspiration (carried out under local or general anaesthetic)
Medical;
- Mifepristone (a progesterone antagonist which changes the lining of the womb), followed 24-48 hours after by misoprostrol (a prostaglandin which increases contractions and dilates the cervix to pass out foetus
What are the surgical and medical options from ToP in those that are pregnant 14 weeks or more ?
Surgical;
- Vacuum aspiration or dilation and evacuation (D&E)
Medical;
- Mifepristone (a progesterone antagonist which changes the lining of the womb), followed 24-48 hours after by misoprostrol (a prostaglandin which increases contractions and dilates the cervix to pass out foetus
- Its administered in medical facility as its like a miscarriage
What is the ethical debate about allowing misoprostrol in those less than 14 weeks pregnant to take it at home?
Some argue it will benefit the welfare of women as it;
1) . Saves the patient having to come back into the clinic for a second time (acts as a barrier if they have to come back again)
2) . Many women also experience the distress of bleeding and cramp pain on their journey home
What does WHO state are the characteristics of abortion procedures via Medical abortion?
Medical abortion (pills only);
- Avoids surgery
- Mimics miscarriage
- Controlled by the woman and may take place at home (at less than 9 weeks of pregnancy)
- Takes time (hours to days) to complete abortion, and the timing may not be predictable
- Women experience bleeding and cramping, and potentially some other side effects (vomiting, nausea)
- May require moire clinic visits than surgical abortion
In what situations may Medical abortion be necessary ?
Medical abortion may be necessary in the following situation;
- For severely obese women
- If the woman has uterine malformations or fibroids, or has had previous cervical surgery
- If the woman wants to avoid surgical intervention
- If a pelvic examination is not feasible or is unwanted
What does WHO state are the characteristics of abortion procedures via Surgical abortion?
Surgical abortion;
- Quick procedure
- Complete abortion is easily verified by evaluation of aspirated products of conception
- Takes place in a healthcare facility
- Sterilisation of the woman or placement of an intrauterine device (IUD) may be performed at the same time as the procedure
- Requires instrumentation of the uterus
- Small risk of uterine or cervical injury
- Timing of abortion is controlled by facility and provider
In what situations may Surgical abortion be necessary ?
Surgical abortion may be necessary in the following situation;
- If there are contraindications to medical abortion (drug shouldn’t be used as may affect patients other health conditions)
- If there are constraints for the timing of the abortion
How many abortions in Scotland (2018) are done under 9 weeks and over 18 weeks?
80% of abortions are done under 9 weeks
Less than 1% are done over 18 weeks
What percentage of abortions in Scotland (2018) are Medical abortions?
86.1%
What are the different reasons and codes for abortions under the Abortion Act 1967 (1990)?
- A - ‘Social grounds’ (up to 4 weeks) - The pregnancy has not exceeded the 24th week and the continuation of the pregnancy would involve a 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 her family
- B - ‘Grave permanent injury’ - The termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
- C - ‘Risk to life’ - The continuance of the pregnancy would involve risk to the life of the pregnant woman, grater than if the pregnancy were terminated
- D - ‘Fetal abnormality’ - There is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped
What are the statistics for abortion reasons in Scotland (2018)
- 8% were for reason 1.A - Social grounds
1. 2% were for reason 1.D - Fetal abnormality
What percentage and number of abortions worldwide are carried out unsafely, and where does the majority of the occur?
Almost half of abortions worldwide are unsafe (25 million)
97% of these unsafe abortions occur in developing countries