Abortion

Reviewed by Dr Philip Owen, consultant obstetrician and gynaecologist

What can be done about an unwanted pregnancy?

Terminating a pregnancy is a major decision and an extremely difficult one to make. It is advisable that the woman discusses her concerns with someone close who she can trust.

Women should always contact their GP if they are pregnant and do not want to continue with the pregnancy.

In the UK it is legal for termination to be carried out up to 24 weeks of pregnancy, but most hospitals and clinics will not consider termination beyond 18 to 20 weeks. For this reason alone, if a woman is considering termination, then she should discuss the situation with her GP sooner rather than later.

The law states that two doctors need to agree that the abortion can be carried out. They will reach this decision if they believe there is a greater risk to the woman's mental or physical health if she continues with the pregnancy than if she has an abortion. The doctor can also take social circumstances into account when making this decision.

The doctor will then usually examine the woman to determine how long she has been pregnant, and also tell her about the options for termination and the risks involved. The doctor will send this request to the nearest hospital or clinic, which will then make an appointment for the termination to be performed. Many hospitals now have early pregnancy clinics for this reason, staffed by nurses and doctors who will deal with the problems sensitively.

What kind of examination will the doctor make?

The doctor will make a pelvic examination to determine the length of the pregnancy. During this examination the doctor may also take a sample from the vagina to check for a bug called Chlamydia. If this test is positive, both the woman and her partner should undergo treatment.

An ultrasound scan may also be used in the hospital or clinic to be certain of the length of the pregnancy.

What are the different methods for termination of pregnancy?

There are two commonly used methods.

An abortion pill. This is for pregnancies up to nine weeks old and involves taking two drugs – called mifepristone and prostaglandin – 48 hours apart. These have the effect of causing the womb to contract and shed its lining so that the embryo is lost through the vagina. This can be painful and some women feel sick or have vomiting and diarrhoea with these drugs.

A surgical termination can be performed up to 13 weeks. This may be performed under local or a general anaesthetic. A sterile tube is introduced into the uterus through the cervix. Suction is applied through the tube and the pregnancy terminated. Most women leave hospital on the same day. From 14 to 19 weeks the technique is slightly different in that it is known as a surgical dilation and evacuation where the neck of the womb is stretched open to allow forceps to remove the foetus.

A medical termination can be performed up to 24 weeks. This involves giving the patient a course of two different types of medicine. The first medicine (mifepristone) is taken by mouth at the hospital or clinic, with the woman returning 48 hours later. She will then be given a medicine called a prostaglandin, either by mouth or as a vaginal pessary. The termination usually occurs within 12 hours of this when the woman passes the pregnancy vaginally. Pain, is often experienced but pain relief will always be available. (Surgical termination is also available at the 20-24 week stage although this is more complicated and requires a two-stage process. The first stage involves stopping the heart of the foetus and softening the neck of the womb, and the second stage occurs the next day by surgical evacuation.)

The type of termination a woman is offered will depend upon the length of her pregnancy, the facilities available and also her personal preference.

What complications may arise from a termination?

Fewer complications arise if the pregnancy is terminated within 10 weeks. If a woman suspects that she is pregnant, and does not want to continue with the pregnancy, she should contact her GP as soon as possible.

There is no such thing as an operation or procedure that is completely risk-free. Termination of pregnancy, whether medical or surgical, is a safe procedure but complications are possible.

The most common complications are described below.

Bleeding After the abortion it is normal to bleed for a couple of days. After that, the bleeding will decrease for a couple of weeks. A period or menstruation will, in most cases, occur after five to six weeks. If the woman bleeds more heavily than she would normally, it could be because her uterus has not been emptied completely. If this is the case she should ask a doctor to examine her. This complication applies to both medical and surgical terminations.

Pelvic inflammatory disease

If a woman has an unpleasant vaginal discharge, a temperature and abdominal pains, she should contact her doctor. Inflammation can occur if the uterus has not been emptied properly, or if bacteria have got into the uterus during the operation. The inflammation is treated with antibiotics. If some tissue still remains in the uterus, it may be necessary to remove it with a new evacuation of the womb. Baths, swimming pools and unprotected sexual intercourse should all be avoided until any bleeding has stopped. This complication applies to both medical and surgical terminations.

Pain

It is normal to have mild pain across the lower abdomen for the first couple of days after a termination. If the pain is not reduced by normal pain killers the woman should contact her doctor.

Puncture of the uterus

During a surgical termination, inserting the suction device may risk puncturing a hole in the uterus. If the doctor suspects this, the operation will be stopped and the patient will be kept in hospital for observation. This complication is rare and does not apply to medical terminations.

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