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Abortion
Last reviewed: 23.04.2024
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Worldwide, 1/3 of pregnancies are interrupted. Good contraceptives reduce the need for this intervention, but do not completely eliminate it. About 150,000 such procedures are performed annually in the UK.
Legislation
The law on abortion from 1967 (supplemented by the Legislative Act on the fertilization and embryology of a person from 1990) permits the termination of pregnancy up to 24 weeks in the event that it
- reduces the risk existing for a woman's life;
- reduces the risk existing for a woman's physical and mental health;
- reduces the risk that exists for the physical and mental health of the living children of this woman.
Article 1 provides a technical basis for the interruption of any early pregnancy, since it is safer than childbirth, but 90% of the termination of pregnancy is explained in Article 2 ("social" article). Two doctors must sign the HSA / 1 form. For pregnant women under the age of 16, the consent of the parents (and the patient herself) is required.
There are no restrictions on the timing of an interrupted pregnancy, if
- there is a threat to the life of the mother;
- the risk of serious harm to the physical / mental health of the mother (taking into account the objective circumstances that the mother may foresee in the future);
- a reasonable risk that, if the child is born, he will suffer such a severe physical or mental illness that this will cause severe disability.
After 20 weeks, usually after amniocentesis, or when a very young mother or woman during the menopause did not recognize pregnancy earlier, abortion is performed in less than 1% of cases. Termination of pregnancy after 24 weeks can be performed only in the conditions of the National Health Service hospitals.
Decision on abortion
A woman will have to live with her thoughts about her deed for the rest of her life. The council can help her choose the solution, which she will regret least of all.
- Is she really pregnant? Perform a vaginal examination to determine the timing of pregnancy.
- Does she really want to end the pregnancy? Why? Whether she considered other options - discuss their possibility. What does her partner think about this? Ideally, you should give her time to think things over and make a decision during the next consultation. If it selects an interrupt:
- Discuss the use of contraceptives (it can start taking them on the next day, if desired);
- set the sequence of further actions. If the patient is Rh-negative, she will need to introduce an anti-D-HM immunoglobulin. At the time of termination of pregnancy, she can survive real stress.
[Ways of abortion
The most common method of termination of pregnancy in the first trimester is the expansion of the cervix with subsequent curettage or vacuum-aspiration of the contents of the uterus. Mortality is low (1: 100 000), the risk of infectious complications is small.
During the second trimester, labor is induced by intravaginal administration of prostaglandins in the form of a gel or pessaries, for example, gemeprost (Gemeprost) at a dose of 1 mg for 3 hours, with a gradual increase in the dose to 5 mg in 24 hours. Oxytocin may be required to stimulate uterine contractions and surgically remove placental residues. The procedure can be long, painful and psychologically traumatic. An alternative method is emptying the uterus using a surgical method using forceps. The method is very unpleasant to perform, and when the required expansion of the cervix, even after the preliminary application of prostaglandins, it can damage it. After 14 weeks, mortality and morbidity increase as the duration of pregnancy increases.
Medical abortion of pregnancy (more than 9 weeks of pregnancy) is a 4-step procedure performed in special clinics.
- Discussion and conduct of ultrasound.
- Under the supervision of the staff, mifepristone (Mifepriston) is administered at a dose of 600 mg orally (RU486, antiprogestron), a disimplanting fetal egg.
- Abortion is completed by the introduction of pessary with 1 mg of gomeprost in 36-48 hours after the previous manipulation. Earlier in this stage only 3% of abortions are produced.
After 12 weeks, follow-up and ultrasound examination is performed. Surgical intervention is required by 5% of patients. Psychiatric disorders are observed in the same number of patients as after a surgical termination of pregnancy.