Termination of Pregnancy - Abortion

Question 1

Legal framework around abortion

Answer 1

Can only happen in approved premises where 2 medical practitioners agree that either

-U24wks + continuation would lead to risk of injury to physical or mental health of mother or existing children in the family
-termination needed to prevent grave permanent injury to physical/mental health of mother
-continuation would involve risk to life of mother
-substantial risk that child would suffer serious physical/mental abnormalities

Question 2

Methods of abortion
-medical
-surgical
Pros and cons

Answer 2

Medical - PO mifepristone =(24-48hrs)=> PV/PO misoprostol

Avoids surgery if successful
May take place at home depending on stage of pregnancy, or in healthcare setting
Avoids pelvic examination or insertion of instruments into uterus
Medication SE - N/V/D, fever
Cramping and abdo pain - can bleed for 2-3wks
May see pregnancy when it passes
All contraception can be started at time of medical abortion, except IUDs which are inserted once pregnancy expelled

Surgical - performed with LA/conscious sedation+LA/deep sedation/GA
-Manual vacuum aspiration
-Electric vacuum aspiration
-dilation and evacuation

Involves surgery
-bleeding
-infection
-pain
-cervical injury from dilation and manipulation
-uterine perforation
Cannot take place at home
Medication used to prepare cervix SE - cramps, bleeding, N/V/D, fever
Reduced discomfort due to presence of sedation/anaesthetic
All contraceptive methods can be started at time of procedure

Question 3

Risks of abortions

Answer 3

Safest when carried out as early as possible

No increased risk of
-infertility
-breast cancer
-MH issues