Termination of pregnancy

Question 1

A

Answer 1

The continuance of pregnancy would involve risk to the life of the pregnancy woman greater than if the pregnancy were terminated

Question 2

B

Answer 2

The termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman

Question 3

C

Answer 3

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

Question 4

D

Answer 4

The pregnancy has not exceeded 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 children of the family of the pregnant woman

Question 5

E

Answer 5

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

Question 6

F (emergency)

Answer 6

To save the life of the pregnant woman

Question 7

G (emergency)

Answer 7

To prevent grave permanent injury to the physical or mental health of the pregnant woman

Question 8

Gestation and termination

Answer 8

By law you can terminate a pregnancy at any gestation under grounds A, C, E, F, G

Very rare over 24 weeks

If under E and after 24 weeks usually perform fetocide first

Question 9

UK statistics

Answer 9

92% of abortions were carried out at under 13 weeks in 2014/15/16

81% were under 10 weeks in 2016 compared to 80% in 2014, 79% in 2013 and 68% in 2006

Question 10

Grounds for abortion

Answer 10

97% carried out under ground C

1% carried out under ground D

2% carried out under ground E

Question 11

Doctor’s right

Answer 11

No person shall be under any duty to participate in any treatment authorised by this act to which they have a conscientious objection

Question 12

Terminations

Answer 12

Free of NHS

Carried out within a licensed clinic

• NHS
• BPAS
• marie stokes
• brook

Referral via GP/ family planning doctor

Discussion re whether 2 doctors are required

Post termination contraception

Chlamydia screening

Question 13

Surgical abortion

Answer 13

Usually under 12-14 weeks

Vacuum aspiration

GA or local anaesthesia

Over 14 weeks (rare)

Dilation and evacuation

Question 14

Medical abortion

Answer 14

Progesterone antagonist (mifepristone) orally: stops the pregnancy

Combined with misoprostol vaginally: starts 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 clinic but can still go home

Question 15

Risks with abortion

Answer 15

Mortality: 0.6 deaths per 100,000 abortions

Failure: 0.2% after surgical and 0.7% after medical

Incomplete abortion (1%)
Excessive bleeding (0.1%)
Uterine damage (surgical, 0.5%)
Infection (<1%)

Question 16

Long term sequelae

Answer 16

No association between abortion and

• ectopic pregnancy
• infertility
• placenta praevia
• preterm birth
• psychological effects