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termination of pregnancy
Last reviewed: 08.07.2025
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Worldwide, 1/3 of pregnancies are terminated. Good contraception reduces the need for this intervention, but does not eliminate it. Around 150,000 such procedures are performed each year in the UK.
Legislation
The Abortion Act 1967 (as amended by the Human Fertilization and Embryology Act 1990) allows termination of pregnancy up to 24 weeks if it
- reduces the risk that exists for a woman's life;
- reduces the risks that exist for a woman’s physical and mental health;
- reduces the risk that exists for the physical and mental health of this woman's living children.
Article 1 provides the technical basis for the termination of any early pregnancy, as it is safer than childbirth, but 90% of pregnancy terminations are explained by Article 2 (the "social" article). Two doctors must sign the HSA/1 form. For pregnant women under 16, parental consent (and the patient's own) is required.
There are no restrictions on the timing of termination of pregnancy if
- there is a threat to the mother's life;
- the risk of causing serious harm to the physical/mental health of the mother (taking into account objective circumstances that the mother can foresee in the future);
- a reasonable risk that, if the child is born, the child will suffer from such a severe physical or mental illness that it will cause severe disability.
After 20 weeks, usually after amniocentesis or when a very young mother or a woman in menopause has not recognised the pregnancy earlier, terminations are carried out in less than 1% of cases. Terminations after 24 weeks can only be carried out in National Health Service hospitals.
Decision to terminate pregnancy
The woman will have to live with the thoughts of what she did for the rest of her life. Advice can help her choose the decision she will regret the least.
- Is she really pregnant? Perform a vaginal examination to confirm the pregnancy period.
- Does she really want to terminate the pregnancy? Why? Has she considered other options - discuss them. What does her partner think about this? Ideally, you should give her time to think about it and make a decision at the next consultation. If she chooses to terminate:
- discuss taking contraceptives (she can start taking them the next day if she wishes);
- establish a sequence of further actions. If the patient is Rh negative, she will need to be given anti-D-HM immunoglobulin. At the time of termination of pregnancy, she may experience real stress.
[ Methods of Termination of Pregnancy
The most common method of terminating pregnancy in the first trimester is dilation of the cervix followed by curettage or vacuum aspiration of the uterine contents. Mortality is low (1:100,000), the risk of infectious complications is small.
During the second trimester, labour is induced by intravaginal administration of prostaglandins as a gel or pessary, such as gemeprost 1 mg over 3 hours, gradually increasing the dose to 5 mg over 24 hours. Oxytocin may be required to stimulate uterine contractions and surgical removal of the placental remnants. The procedure can be lengthy, painful and psychologically traumatic. An alternative is surgical evacuation of the uterus using forceps. This is very uncomfortable to perform and may injure the cervix when dilating as required, even after prostaglandins have been administered. After 14 weeks, mortality and morbidity increase as the pregnancy progresses.
Medical termination of pregnancy (more than 9 weeks of pregnancy) is a 4-stage procedure performed in special clinics.
- Discussion and implementation of ultrasound examination.
- Under the supervision of staff, mifepristone (Mifepristone) is prescribed at a dose of 600 mg orally (RU486, antiprogesterone), which disimplants the fertilized egg.
- The abortion is completed by inserting a pessary with 1 mg of homeprost 36-48 hours after the previous manipulation. Only 3% of abortions are performed before this stage.
After 12 weeks, a control examination and ultrasound examination are performed. Surgical intervention is required in 5% of patients. Mental disorders are observed in the same number of patients as after surgical termination of pregnancy.