L16 Termination of pregnancy Flashcards
How many categories are the legal basis for 2 doctors to sign off for abortions?
5 main ones and 2 emergency ones
Ground A
The continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy was terminated
Ground B
The termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
Ground C
The pregnancy had NOT exceeded 24 weeks and that the continuance 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
Ground D
The pregnancy has not exceeded 24 weeks and the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of any existing children
Ground E
There is substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped
Ground F (emergency)
To save the life of the pregnant woman
Ground G (emergency)
To prevent grave permanent injury to the physical or mental health of the pregnant woman
Gestation and termination of pregnancy
By law you can terminate a pregnancy at any gestation under grounds A,C,E,F,G
But very rare over 24 weeks
-viability - changed from 28 weeks when law commenced
If under E and after 24 weeks usually perform foeticide first
What year was the abortion act made?
1967
UK statistics
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 2008
In England and Wales the number of TOPs has declined since 2006, including under 16 abortion rates
Stats for 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 child born handicapped)
246 under Ground A and B
6 cases under Ground F or G
Trend of abortions since 1967-2016
general increase indicating rising rates of terminations or better collection of data
has started to flatten out
Doctor’s right to choose - 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
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 complete the paperwork including consent but not the legal form and care for the patient after termination
They have a duty to refer the patient to another doctor for the procedure
Age related terminations
Peak age to have abortion around 20-24
then declines
Place of termination from 1981-2015
Decrease in the amount privately funded
Increase in NHS funded
Terminations
Free on the NHS
Carried out within a licenses clinic
Referral via GP/family planning doctor (2 doctors 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 (prostaglandin 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 100,00 abortions (no deaths in 2014 but 1 in 2015 and 1 in 2016)
Failure: 0.2% after surgical and 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
