Termination of Pregnancy

Question 1

Legal Aspects

Answer 1

Can be legally performed up to 24 weeks gestation
UK Abortion Act (1967): If two medical practitioners acting in good faith are willing to certify one of the following 4 criteria:
Continuation of pregnancy risks life of pregnant woman
Required to prevent grave permanent injury to physical/mental health
Risk to injury to physical/mental health of existing children
Substantial risk to suffer from physical or mental abnormalities
Needs to be signed by both medical practitioners prior to being performed

Question 2

Conscientious Objection

Answer 2

Medical practitioner not required to participate in abortion unless necessary to save the life of the pregnant woman
Should still advice and refer promptly to another doctor to consider and arrange termination if appropriate

Question 3

Assessment

Answer 3

Confirmation of pregnancy 
Assessment of gestation: Date of LMP, pelvic/abdo exam performed, most will have US scan
Infection screen: Chlamydia
Anti D if Rh-ve
Cervical Smear if due

Question 4

Counselling

Answer 4

Supportive
Non judgmental setting offering adequate information and explanation
Consent by women’s partner is not required
Individual woman’s feeling for pregnancy, abortion, partner, future life plans and ability to care for child currently and in the future
Type of procedure and risk
Professional and personal support before and after abortion
Follow up and contraception after abortion

Question 5

Techniques

Answer 5

Should be performed at earliest possible gestation, lowest rates of morbidity and mortality
First trimester surgical: manual vacuum aspiration following cervical dilation
First trimester medical: Mifepristone (Antiprogestogen) followed by pessary prostaglandin
Late abortion: Medically with mifepristone and pessary or surgical dilation and evacuation of GA

Question 6

Incomplete Abortion

Answer 6

Placenta or foetal tissue may remain in uterus
Many women will spontaneously pass with time, but surgical evacuation might be required if heavy bleeding or cervical dilatation
Infection and subfertility: Febrile illness, offensive vaginal discharge, lower abdominal pain and tenderness, antibiotic therapy started
Traumatic injury
Psychological: Minimised if well counselled prior to abortion, post termination support

Question 7

Follow up care

Answer 7

TCI 2 weeks following: Many in GP or sexual health setting: Ensure abortion is complete, exclude ongoing pregnancy, check of infection advice on contraceptive and sexual health