T2 L16:Terminations of Pregnancy Flashcards
what are the interview themes when a woman asks for an abortion
- Education/training relating to termination of pregnancy
- Religious background
- Tolerance
- Reasons for termination of pregnancy
- Gestation and legal time limits
what are the 5 main categories that are the legal basis for 2 doctors to sign off a termination of pregnancy in routine practice.
& what is special about grounds C & D.
A- the continuance of the pregnancy would involve risk to the life of the pregnant woman greater 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
Ground C and D have a gestation limit of 24 weeks but the others don’t.
According to the 1967 Abortion act :
In an emergency what are the 2 other acts
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 occurs if there is termination of pregnancy under grounds E and after 24 weeks
-Usually perform fetocide first
what is the most common gestation for abortion
under 13 and 10 weeks
Why and how can a doctor choose to not participate in abortion
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
what is surgical abortion
Usually under 12-14 weeks
Vacuum aspiration
GA or local anaesthesia
Over 14 weeks (rare)
Dilation and evacuation
what is 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
what are the non-related long term sequelae
No association between abortion and:
- Ectopic pregnancy
- Infertility
- Placenta praevia
- Preterm birth
- Psychological effects
