Termination of pregnancy

•  An abortion can be performed before 24 weeks if continuing the pregnancy involves greater risk to the physical or mental health of:

  • The woman
  • Existing children of the family
• An abortion can be performed at any time during the pregnancy if:

  • Continuing the pregnancy is likely to risk the life of the woman
  • Terminating the pregnancy will prevent “grave permanent injury” to the physical or mental health of the woman
  • There is “substantial risk” that the child would suffer physical or mental abnormalities making it seriously handicapped
• The legal requirements for an abortion are:

  • Two registered medical practitioners must sign to agree abortion is indicated
  • It must be carried out by a registered medical practitioner in an NHS hospital or approved premise
• A medical abortion is most appropriate earlier in pregnancy, but can be used at any gestation. It involves two treatments:

  • Mifepristone (anti-progestogen)
  • Misoprostol (prostaglandin analogue) 1 – 2 day later
• Mifepristone is an anti-progestogen medication that blocks the action of progesterone, halting the pregnancy and relaxing the cervix.
• Misoprostol is a prostaglandin analogue, meaning it binds to prostaglandin receptors and activates them. Prostaglandins soften the cervix and stimulate uterine contractions. From 10 weeks gestation, additional misoprostol doses (e.g. every 3 hours) are required until expulsion.
• Rhesus negative women with a gestational age of 10 weeks or above having a medical TOP should have anti-D prophylaxis.
• Surgical abortion can be performed, depending on preference and gestational age, under:

  • Local anaesthetic
  • Local anaesthetic plus sedation
  • General anaesthetic
• Prior to surgical abortion, medications are used for cervical priming. This involves softening and dilating the cervix with misoprostol, mifepristone or osmotic dilators. Osmotic dilators are devices inserted into the cervix, that gradually expand as they absorb fluid, opening the cervical canal.
• There are two options for surgical abortion:

  • Cervical dilatation and suction of the contents of the uterus (usually up to 14 weeks)
  • Cervical dilatation and evacuation using forceps (between 14 and 24 weeks)
• Post-abortion care:

  • May experience vaginal bleeding and abdominal cramps intermittently for up to 2 weeks after
  • A urine pregnancy test is performed 3 weeks after to confirm abortion is complete
• Complications:

  • Bleeding
  • Pain
  • Infection
  • Failure of the abortion (pregnancy continues)
  • Damage to the cervix, uterus or other structures