Therapeutic Abortion Any pregnancy medically induced at < 24 weeks gestation or weighing < 500g Abortion act 1967 (amended by Human Fertilisation and Embryology Act 1991) 2 doctors must sign (if you wont you must refer to another doctor who would) All doctors have a duty to treat in an emergency situation A – to save mothers life B – to prevent grave permanent injury to mothers physical or mental health C – if < 24 weeks to avoid injury to mothers physical/mental health D – if < 24 weeks to avoid injury to physical/mental health of existing children E – if the child is likely to be severely physically or mentally handicapped Counselling should be non-directive, include the options of adoption and make clear than abortion can affect chance of future pregnancy (by infection) Options based on gestation < 6 weeks – manual vacuum evacuation 6-9 weeks – 1st choice medical (surgical under special circumstances) 9-12 weeks – surgical 12+ weeks – 1st choice medical (Dilatation & evacuation possible) Medical termination 1st trimester Mifepristone (anti-progesterone = RU486) oral à admit 36-48 hours later Give prostaglandin or misoprostol pessary (PGE2 analogue - upto 800mcg) to soften cervix & synergistic with mifepristone as antiprogestigen. In 80% à pass products of conception in 4hrs Confirm complete products passed before discharge Usually bleed for 10 days Follow up at 2 weeks to assess bleeding and confirm complete abortion (bimanual exam / USS) Less than 5% require evacuation 2nd trimester Oral mifepristone & vaginal prostaglandins (as in 1st trimester) Pessaries at 6 hourly intervals à most abort with 24 hours (average 8 hrs) + Analgesia & emotional support Confirm placenta is complete & uterus contracted (by bimanual) 6% require evacuation Surgical termination Misoprostol pessaries 4 hrs pre-op to soften cervix & minimise trauma Cervical dilators to dilate os Suction to aspirate the fetus & placenta Requires morcellating after 12 weeks (very unpleasant and very rarely done) Follow up Offer counselling Ensure effective contraception offered to prevent recurrence