This Page about miscarriage with References can be viewed here
1-Definition: What does the term 'abortion' mean?
Abortion (also referred to as pregnancy termination) means expulsion of a pregnancy before the fetus (baby) is viable (capable of survival outside the womb). This contrasts with the lay view, which usually assumes that an abortion means that the pregnancy has been deliberately terminated. A spontaneous abortion (Miscarriage) means that the pregnancy has been lost as a result of a natural process. Many of us find the terms 'miscarriage' or 'early pregnancy loss' to be more user friendly.
In the UK there are strict legal criteria that permit a doctor to terminate a pregnancy. When a pregnancy is terminated by someone who is not medically qualified the termination is illegal (illegal abortion).
2. What are the Legal criteria in the UK for pregnancy termination?
Two doctors must sign the appropriate form in advance of termination of pregnancy indicating which of the following criteria pertains:
- The continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated.
- The termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman.
- 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.
- 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 any existing child(ren) of the family of the pregnant woman.
- 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.
3. How can we screen for serious inherited disorders?
Thirty years ago our ability to diagnose serious inherited disorders or anatomical abnormality (deformity) before birth was very limited. Technological advances, particularly the combination of blood screening tests and ultrasound now allow us to exclude many, but by no means all, of these problems. The question of screening for foetal abnormality is never an easy one. Some would find the thought of caring for a handicapped child intolerable whereas others believe the practice of pregnancy termination is unacceptable. It is only feasible to provide a brief account of the principles, benefits and risks here. When screening indicates that the fetus has a serious defect, there are two options. Many couples elect to continue the pregnancy and the obstetrician in collaboration with the paediatrician can counsel on what is to be expected and the treatment options for the baby. Other couples decide that they do not wish the pregnancy to continue and termination can be arranged. Counselling may be offered to provide support for you to come to terms with a decision to discontinue a planned pregnancy. You will also need advice on the chance of recurrence in another pregnancy. Your gynaecologist may be able to supply you with this information or otherwise arrange for you to see a clinical geneticist.
The spina bifida group of defects, and heart and limb defects may be demonstrated by ultrasound. Some families are prone to inherited disorders and many of these can be detected by specific screening techniques.
are discussed in screening tests
4 How often is abortion performed?
Legal abortion is the most frequently performed operation in the UK with about half these operations being undertaken within the NHS. Forty per cent of women in the UK will have had a pregnancy terminated by the age of 45 years. It has been estimated that worldwide 150,000 pregnancies are terminated each day (about one million each week and 350 million each year)! In some countries, such as Russia, more pregnancies are terminated than continue. Many Russian women will have between three and eight pregnancy terminations. There were 10 million terminations in China in 1987. Since the fall of communism in Romania, nearly four out of every five pregnancies are terminated. There are currently about six billion people in the world. This is increasing by 1 billion every ten years.
5 Why do unplanned pregnancies occur?
Perhaps one of the most frustrating problems for gynaecologists is the number of pregnancy terminations that occur when effective contraception seems to be so readily available: in the UK contraception is available without charge. There are a number of reasons for this. Many people, particularly the young and therefore the most vulnerable, find contraception an embarrassing issue. Love-making involves intimacy, spontaneity, immediacy and of course pleasure. Most forms of contraception require preparation and discussion and every method carries an element of risk or at the least appears an imposition or intrusion. Biology is about life and continuation of the species. Perhaps we have to understand that one of nature's strongest driving forces can prove stronger than reason.
6 I do not want this pregnancy. What should I do?
Start by confirming that you really are pregnant. Pregnancy tests available from your chemist are very accurate. The test may become positive within eight days of conception or about six days before your next period is due. If your period is a few days late, arrange for a test and if it is positive see your general practitioner.
7 Should I terminate my pregnancy for social reasons?
This must be one of the most difficult decisions a woman ever faces. When there is doubt careful counselling may help. The counsellor cannot make the decision for you. The purpose of counselling is to help you sort out the facts and decide for yourself the best option for you.
8 How can my pregnancy be terminated?
This will depend on the duration of the pregnancy, and your choice when there are options.
In the UK pregnancy duration is calculated from the first day of the last menstrual period (LMP). The majority of pregnancy terminations are performed before the 13th week. Medical abortion may be an option at less than nine weeks. Vacuum curettage (suction termination may be used up to 13 weeks. From 13 weeks to 20 weeks the cervix can be dilated and the uterus emptied (dilatation and evacuation). Medical induction of labour is an option from 13 to 24 weeks. Sometimes the obstetrician may recommend hysterotomy (like a mini-Caesarean section) beyond 20 weeks.
9 What does a surgical termination of pregnancy involve?
In the UK this is usually carried out under general anaesthesia but some employ local anaesthetics. It is usually a day-case procedure. The cervix (neck of the womb) is gently stretched (dilated). A special suction catheter is then introduced through the cervix into the cavity of the womb. The catheter is connected to a suction pump and the womb is carefully emptied.
10 What is a medical termination of pregnancy?
Medical abortion (the medical termination of pregnancy) involves terminating a pregnancy without a surgical procedure. Progesterone is essential for the maintenance of pregnancy. Mifepristone (RU486) is a progesterone antagonist . Three tablets of Mifepristone are followed by a vaginal pessary 36-48 hours later. Mifepristone appears to be a safe drug with few side effects.
11 What will happen to me if I have a medical pregnancy termination?
You will need to take the Mifepristone tablets at the unit supervising the pregnancy termination. After a couple of hours, you may go home and continue with your usual activities. There is a 40% chance of bleeding during the next two days and a 2% chance that you will miscarry during this time.
Thirty-six to 48 hours after taking the Mifepristone, you will be admitted and given a vaginal pessary. There is a 70% chance that you will miscarry during the following 4 hours. Should nothing happen within eight hours of the pessary, you may be allowed home and a scan arranged a few days later.
12 How do medical and surgical pregnancy termination compare?
Medical termination in theUK can only be used before nine completed weeks of pregnancy. It avoids the surgical complications and it may seem more like a ‘natural’ or spontaneous miscarriage. Surgical termination requires one visit for the treatment whereas a second visit is required with the medical protocol. There is some encouraging evidence that medical termination of pregnancy may be effective beyond the ninth week.
13 What are the chances of a medical termination failing?
Usually the womb empties itself completely after medical termination. Once in every twenty five cases, the uterus may only partially empty; the doctors are likely to recommend an E.R. P.C (evacuation of retained products of conception – like a D and C but specific for miscarriage (Q12.8). Medical abortion only fails once in a hundred pregnancies.
14 What are the risks of pregnancy termination?
The general risks of surgical procedures are described in surgery risks. A number of specific complications of pregnancy termination are quoted, but research has shown that the risks are low and not as worrying as the anti-abortion lobby tends to suggest. The risks increase as the pregnancy becomes more advanced. The concerns include the risk of reduced fertility, future miscarriage and depressive illness. There are a number of difficulties in evaluating the incidence of these complications. For example, a significant number of those seeking pregnancy termination are at increased risk of pelvic infection (Q 20.2).
The uterus is soft during pregnancy and it can be perforated either during dilation of the cervix or during suction with the possibility of damaging other structures in the pelvis including the bowel and the bladder.
The cervix may tear during dilatation. As instruments are introduced through the lower genital tract into the uterus there is a risk of pelvic infection (Q 20.2) which is increased if some pregnancy products are inadvertently retained. There is evidence that prophylactic (preventative) antibiotics reduce the risk. Some clinicians advocate taking swab tests from the neck of the womb and administering antibiotics only if bacteria are cultured. This protocol allows identification of sexually transmitted disease and facilitates contact tracing, thus reducing the incidence of sexually transmitted disease.
The commonest cause of pregnancy related deaths worldwide remains pregnancy termination. The number of women dying each day from termination complications is about 500 (1 in 300 of all pregnancy terminations, including those undertaken without medical supervision). My generation of British gynaecologists has been spared the tragic sight of women dying due to illegal termination. It is pertinent to point out that in the three years before the Abortion Act of 1967, ninety-eight women died as a result of back-street abortions.
During my first weekend on call as a senior house officer in gynaecology, we were looking after a woman who had a surgical termination of pregnancy carefully performed by an accomplished consultant. The patient was married and the couple had no child. They had wished to delay parenthood for social reasons. During the operation there was bleeding and despite the team's best efforts, a life-saving hysterectomy was necessary.
There has been a suggestion that pregnancy termination may be associated with an increased risk of breast cancer later in life.
Pregnancy termination does not appear to increase the risk of miscarriage in a subsequent pregnancy.
15 Why is there debate about the ethics of pregnancy termination?
Termination of pregnancy (induced abortion) probably began well before written history. There is a fundamental clash between the rights of a woman who does not wish her pregnancy to continue and the sanctity of life coupled with the rights of the unborn child.
Before 1967, it was illegal to terminate (abort) a pregnancy in the UK. The case of a fourteen-year old girl who was raped by officers of the Royal Horse Guards in 1938 illustrates the difficulty. The parents sought an abortion for their daughter. Understandably, they argued that the baby would remind their daughter of her frightening experience. The girl was admitted to hospital under the care of Mr Aleck Bourne, a gynaecologist in London. He agreed that termination of the pregnancy was in the girl's best interest and undertook the procedure risking a twenty-year prison sentence. The judge at the Old Bailey accepted that, although the operation had not been performed to save life, it preserved the girls mental and physical health. The jury found in favour of the gynaecologist. This case was undoubtedly a big step on the road to the Abortion Act of 1967. It is noteworthy that Aleck Bourne eventually became a member of the Society for the Protection of the Unborn Child because of his concerns that the Abortion Act would lead to abortion on demand.
16 Support Groups
Members of a support group, provide each other with various types of help and information for a particular shared difficulty. The support may take the form of providing relevant information, relating personal experiences, listening to others' experiences, providing sympathetic understanding and establishing social networks. A support group may also provide ancillary support, such as serving as a voice for the public or engaging in advocacy. Support groups maintain interpersonal contact among their members in a variety of ways. Support groups also maintain contact through printed http://www.behavioral-advice.com information rich newsletters, telephone chains, internet forums, and mailing lists.Behavior problems have been associated with unplanned pregnancy. Advice is available for those who need counselling for relationship problems.
Support groups offer companionship and information for people coping with diseases or disabilities. Support groups may not be appropriate for everyone, and some find that a support group actually adds to their stress rather than relieving it.
Evaluation of the quality of Web sites is discussed in(Q4.27) . You may find that several general women's health sites may help you (internet information). The following are more specialised relevant Web sites:-
Antenatal screening tests:
www.ntsad.org/ (Tay Sachs)
members. Tripod.com/~plpc/ pro-life
British Pregnancy Advisory Service
Austy Manor,Wooten Warren,Solihull,West Midlands B95 6BX Tel: 01564 793225
Marie Stopes Clinics,108 Whitfield Street London W1pBE Tel: 020 7388 2585
National Abortion Campaign The Print House 18 Ashwin Street London E8 3DL Tel: 020 7923 4976
Pregnancy Advisory Service Tel:- 0171 637 8962
ARC (Antenatal Results and Choices) (Previously named - Support Around Termination for Abnormality)73 Charlotte Street London W1pLB Tel 020 7631 0280.
Thank you for choosing to visit us.
This is the personal website of David A Viniker MD FRCOG, retired Consultant Obstetrician and Gynaecologist - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.
- Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.
The aim of this web site is to provide a general guide and it is not intended as a substitute for a consultation with an appropriate specialist in respect of individual care and treatment.David Viniker retired from active clinical practice in 2012.
In 1999, he setup this website - www.2womenshealth.com - to provide detailed
information many of his patients requested. The website attracts thousands of visitors every day from around the world.
Website optimisation (SEO) has became more than an active hobby. If you would like advice on your website, please visit his website Keyword SEO PRO or email him on email@example.com.