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.
For instance, it is often a good idea to consult your GP if you are pregnant and do not want to continue with the pregnancy.
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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 a doctor sooner rather than later.
Also, the earlier a termination is carried out, the safer it is for the woman.
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.
In fact, a quirk in the wording of the 1967 Abortion Act means that virtually any woman can obtain a termination legally if she so desires.
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 a 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 carry out 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 germ called chlamydia. If this test is positive, both the woman and her partner should undergo treatment.
An ultrasound scan may also be used by 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 about 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 womb 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 though such late abortions are now very rare. 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 occasionally performed 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?
Complications are rare if the pregnancy is terminated within 10 weeks. So, if a woman suspects that she is pregnant, and does not want to continue with the pregnancy, she should contact a doctor or clinic 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.
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The most common complications are described below.
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 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 develops an unpleasant vaginal discharge, a temperature and abdominal pains, she should contact a doctor. Inflammation can occur if the womb has not been emptied properly, or if bacteria have got into it 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.
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 painkillers the woman should contact a doctor.
Puncture of the uterus
During a surgical termination, inserting the suction device may occasionally make 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 happen in medical terminations.
Can abortion lead to infertility?
Infertility as a result of a legal termination carried out by a skilled doctor is rare.
Inflammation of the Fallopian tubes and ovaries caused by the chlamydia organism is the most common cause of infertility following an abortion. Examination for chlamydia is now routine in most hospitals and clinics and, if necessary, the patient will be treated before the abortion is carried out.
How to protect against pregnancy after an abortion
It is important that the woman talks to the doctor or clinic about contraception to avoid another unwanted pregnancy. She may start ovulating (producing eggs) before her periods return, so she can become pregnant again before she has her next period.
It is possible to start taking contraceptive pills on the same day as the abortion, which in most cases will give immediate protection. A contraceptive coil can be fitted during the operation. A contraceptive injection can also be given, or a contraceptive implant can be inserted in the arm. You should discuss the options with the doctor or clinic.
Based on a text by Dr Erik Fangel Poulson, specialist
Last updated 29.01.2012