The Abortion Act 1967 was implemented to legalise termination of pregnancy in Great Britain. This has to be under certain stipulations and overseen by 2 registered practitioners.
The requirements to be eligible for termination of pregnancy are any of the following:
- That 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 or any existing children of her family.
- That the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman.
- That the continuance of the pregnancy would involve risk to the life of the pregnant woman, greater than if the pregnancy were terminated.
- That 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.
Two registered practitioners are required to sign a legal documents, however, in an emergency one practitioner may be sufficient. It must be performed in a licensed premises (for example an NHS hospital or licensed private hospital).
Termination of pregnancy
The choice between medical and surgical termination of pregnancy is based on patient preference as well as availability from local services.
🩸 Anti-D prophylaxis
- If a lady is rhesus D negative and are having an abortion after 10+0 weeks gestation → offer anti-D.
- If the lady is having a surgical abortion prior to or including 10+0 weeks gestation they may also be offered anti-D.
🦠 Antibiotic prophylaxis
- Doxycycline - oraly 100mg BD for 3 days.
- Metronidazole may also be used (but if it is used, then do not use doxycycline).
💉 VTE prophylaxis
- Enoxaparin may be used for at least 7 days after abortion. For women at high-risk of thrombosis it may be started prior to the abortion as well.
The medical option for termination of pregnancy involves interval treatment with mifepristone (an anti-progestogen) followed by misoprostol (a prostoglandin). They may be taken at the same time, but doing so carries higher risk of failed termination.
<10+0 weeks
These are usually done at home.
- Mifepristone
- Misoprostol - given 24-48 hours after the mifepristone.
10+1 - 23+6 weeks
These are usually done in clinic or hospital and the woman can usually go home on the same day.
- Mifepristone
- Misoprostol - given 36-48 hours either vaginally or sublingually.
- Manual vacuum aspiration (MVA) - used for pregnancies under 10 weeks.
- Electrical vacuum aspiration (EVA) - used for pregnancies under 10 weeks.
- Dilatation and evacuation (DVA) - used for pregnancies from 14-24 weeks.
For women having surgical abortion up to 13+6 weeks, cervical priming should be done with either:
- 🥇 Misoprostol - sublingually (1 hour prior to abortion) or vaginally (3 hours prior to abortion).
- 🥈 Mifepristone - 24-48 hours prior to abortion.
For women having surgical abortion from 14 - 23+6 weeks, cervical priming should be done with either:
- Osmotic dilators (Dilapan-S) - viable from 14-19 weeks.
- Misoprostol - viable from 14-19 weeks.
- Mifepristone - viable from 19-24 weeks.
Advise women that they may experience vaginal bleeding and abdominal cramps for up to 2 weeks after the procedure.
Pregnancy test required up to 2 weeks after the procedure.
🚨 Complications
- Bleeding
- Pain
- Infection
- Failed pregnancy
- Uterine rupture