Termination of pregnancy

Question 1

Discuss the legalities of termination of pregnancy

Answer 1

• 5 main categories that form the legal basis for 2 doctors to sign off a termination of pregnancy

In emergencies theres a further 2

• to save the life of the pregnant mother
• to prevent grave permanent injury to the physical or mental health of the pregnant woman
• By law, can terminate a pregnancy at any gestation under grounds A,C,E (perform fetocide if >24 weeks),F,G
• If over 24 weeks C and D rare
• Most common grounds for abortion is C: the pregnancy hasnt exceeded 24 weeks and continuation will involve risk to mental and physical health of existing children of the mother

Question 2

Typically when are abortions carried out?

Answer 2

• 92% of abortions were carried out under 13 weeks

- 81% <10 weeks

Question 3

Discuss conscientious objection

Answer 3

Can decide to not carry out abortion but still need to complete the paperwork including consent, but not the legal form and must continue care after termination

Question 4

Where can termination be accessed?

Further management?

Answer 4

Free on the NHS, must be carried out within a licensed clinic (sexual health clinic, BPAS, Marie Stokes, Brook-U25)

• Discussion must involved at least 2 doctors
• Provide post termination contraception as increased fertility after procedure
• Chlamydia screening?

Question 5

Consider the options for surgical abortion

Answer 5

UNDER 12-14 weeks
- vacuum aspiration under general or local anaesthesia

OVER 14 weeks (RARE)
- dilation and evacuation

Question 6

Consider the options for medical abortion

Answer 6

Mifepristone
- oral progesterone anatagonist –> stops the pregnancy

combined with Misprostol
- prostaglandin E1 analogue
- administered vaginally or orally –> starts uterine contractions
(abortion occurs 2-6 hours after administeration)

Question 7

Discuss the legality of medical abortion

Answer 7

Up to 9 weeks both tablets can be taken at home

After that, misoprostol is inserted in the clinic but can go home after

Question 8

What are the risks associated with abortion?

Answer 8

• Mortality = 0.6%
• Failure is 0.2% after surgical intervention or 0.7% after medical
• Incomplete abortion, excessive bleeding, uterine damage (surgery), infection

Question 9

Long term sequelae?

Answer 9

No association between abortion and ectopic pregnancy, infertility, placenta praena, preterm birth or psychological effects