T2 L16 Termination of Pregnancy Flashcards
What are the results of the questionnaire asking about people’s view on termination of pregnancy?
Pro choice = 61%
It’s more complicated than that = 27%
Pro life = 8%
Undecided = 3%
In terms of involvement with abortion what % of medical students were prepared to do the following:
1) Give information
2) Carry out test for foetal anomalies
3) Counsel (as part of the decision making process)
4) Sign forms
5) Write prescriptions
6) Pre operative care
7) Perform abortion procedures
8) Offer after care
1) Give information = 98.9 %
2) Carry out test for foetal anomalies = 95.7 %
3) Counsel (as part of the decision making process) = 93.5 %
4) Sign forms = 78.1 %
5) Write prescriptions = 76.1 %
6) Pre operative care = 85.9 %
7) Perform abortion procedures = 49.5 %
8) Offer after care = 98.2 %
What are the 5 main categories that are the legal basis for 2 doctors to sign off a termination of pregnancy in routine practice?
A the continuance of the pregnancy would involve risk to the life of the pregnant woman greater
appropriate than if the pregnancy were terminated;
B the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman;
C the pregnancy has NOT exceeded its 24th week 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;
D the pregnancy has NOT exceeded its 24th week 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 any existing child(ren) of the family of the pregnant woman;
E 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.
Which of these categories have a legal gestation limit of 24 weeks?
Category C and D
What are the emergency categories of the Abortion Act 1967?
In an emergency:
F to save the life of the pregnant woman
G to prevent grave permanent injury to the physical or mental health of the pregnant woman
What is the law around termination of pregnancy (according to the categories listed above)?
By law you can termination a pregnancy at any gestation under Grounds A, C, E, F, G
But very rare over 24 weeks (Ground C and D)
Viability – changed from 28 weeks when the law commenced
If under E and after 24 weeks usually perform fetocide first
What are the UK statistics for abortion?
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 2006
What are the UK statistics for abortion carried out in the different grounds?
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 that the child would be born handicapped)
246 under Ground A and B
6 cases under Ground F or G
What is the 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, provided that in any legal proceedings the burden of proof of conscientious objection shall rest on the person claiming to rely on it
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
NOTE: Doctors with a conscientious objection still need to the complete the paperwork including consent but not the legal form and care for the patient after the termination. They have a duty to refer the patient to another doctor for the procedure
Describe the overall trend of the statistics relating to age related (of the mother) abortions?
Abortion rates for people over 30 has increased most likely because as maternal age increases the risk of the child having genetic abnormalities is high.
How are terminations carried out?
Free on NHS
Carried out within a Licensed Clinic
- NHS clinic ( inpatient or out patient)
- BPAS
- Marie Stokes
- Brook ( under 25)
Referral via GP/Family Planning Doctor (2 doctors to sign the abortion act form)
Post termination contraception
What is one of the discussion around abortion?
Discussion regarding whether 2 doctors are required
What screening occurs before/during an abortion?
Chlamydia screening
Describe surgical abortion
Usually under 12-14 weeks
Vacuum aspiration
GA or local anaesthesia
Over 14 weeks (rare)
Dilation and evacuation
Describe medical abortion
Progesterone antagonist (mifepristone) orally: stop the pregnancy
Combined with misoprostol (prostagladin 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
