Termination of pregnancy
What is a termination of pregnancy?
A termination of pregnancy is when a pregnancy is ended intentionally. It is often referred to as an 'abortion' - although doctors use the word abortion to mean any pregnancy which ends before 24 weeks gestation whether intentionally or because of a miscarriage. Other than in exceptional circumstances the legal upper time limit for a termination to be done is 24 weeks gestation.
Why is a termination done?
The circumstances under which a pregnancy can be legally terminated are:
- If the pregnancy poses a threat to the life of the mother
- If the pregnancy may seriously affect the mother's physical or mental health
- If the pregnancy may seriously affect the lives of the mother's existing children
- If there is a significant risk of the resulting baby being abnormal
Two doctors must sign a form confirming the reason for the termination before it can proceed. Most terminations are done on the basis of a continuation of the pregnancy being likely to adversely affect the mother's mental health, although a few are performed because of a strong likelihood of an abnormal baby or because an illness that the mother has may be made worse by its continuation (such as breast or cervical cancer).
What choices are available?
Most women who are considering a termination will have confirmed that they are pregnant by doing a pregnancy test either through their physician or by doing a home test. The majority of them will then discuss the options with their physician although some may go to a recognised private clinic. Usually the doctor will help the woman to come to the decision which is the right one for her whether it be to keep or terminate the pregnancy. Sometimes the doctor may perform an vaginal examination to confirm the gestational age of the pregnancy and to make sure that there are no problems within the woman's pelvis.
If the woman decides to have the pregnancy terminated she will then be referred to a gynaecologist for the procedure to be done. The gynaecologist will often see the woman in out-patients to go through the reasons for requesting the termination and to discuss the possible risks before going ahead with the termination.
How is it performed?
The method used for terminating a pregnancy varies according to how many weeks old the pregnancy is, counting from the first day of the last actual menstrual period. Up to 12 weeks of gestation the termination is done in a way similar to a dilatation and curettage. This involves the gynaecologist opening up the neck of the womb with special probes called 'sounds' and then inserting a plastic suction tube into the womb. The contents of the womb are then sucked out. The procedure is usually done under general anaesthetic although in certain cases it can be done under local anaesthetic. The whole operation generally only takes about 10 minutes.
If the pregnancy is more than 12 weeks old a different method usually has to be used called a prostaglandin termination. This involves admitting the woman to a ward and inducing her womb to go into labour using a drug called prostaglandin which is given as vaginal pessaries or jelly. The womb contracts, similar to normal labour, eventually expelling the pregnancy. Unfortunately this process may take several hours and, although sedation is often administered, a general anaesthetic cannot be given for this method. Once the pregnancy has been 'delivered' the woman is taken to the operating theatre to have a D&C (under a quick general anaesthetic) to make sure her womb is completely empty.
Therefore it is important for the woman to seek help and advice as soon as she is aware of an unplanned pregnancy so that a termination can be arranged if possible before 12 weeks is up because the suction procedure is quicker, safer and less distressing.
Are any other methods used?
In 1991 a new 'abortion pill' was licenced for use in terminating pregnancies up to 63 days (9 weeks) of pregnancy. It is known as RU 486 although the actual drug name is mifepristone and it works by preventing the womb from accepting and nurturing a fertilised egg thereby causing the embryo to die and be aborted. Studies have shown that it has a success rate of about 96% but not all women are suitable candidates for it and because the procedure is more complicated than a normal termination it is unlikely to become widely available. RU 486 cannot be obtained from a physician, it is only administered by some hospitals or clinics following normal referral methods.
What are the possible risks?
Terminations, especially those done before 12 weeks of pregnancy, are generally very safe and have a low complication rate. The two most common complications are infection and failure to completely empty the womb. Both of these can cause prolonged heavy bleeding in the days following the procedure so if this occurs, medical advice should be sought. Infection is treated with antibiotics whereas incomplete removal of the womb contents requires a D&C under general anaesthetic to remove the remaining matter. Other complications include perforation of the womb with the suction instrument and trauma to the neck of the womb which may result in a condition called incompetent cervix which could lead to a risk of miscarriage in later pregnancies. Later abortions have a higher complication rate, roughly double that of early ones.
There is no conclusive proof that having an abortion affects future fertility but if an infection follows the procedure this may cause damage to the fallopian tubes (the tubes leading from the womb to the ovaries) which could result in fertility problems.
What happens after a termination?
After an early termination the woman will wake up in the recovery room outside the theatre and, once she has fully recovered, will be allowed home the same day unless there are any complications. It is advisable that someone stays with her the first night after the procedure in case she feels unwell or starts to bleed heavily. Vaginal bleeding should stop after a few days (although it may take longer after a late termination) and the first period should occur about 4 weeks later. Medical advice should be sought if the bleeding becomes heavy, prolonged or painful as this may be a sign of infection or incomplete emptying of the womb.
Return to work is usually possible after 48 hours. It is often suggested that the woman makes an appointment for a check-up with her doctor 2 to 6 weeks after an abortion to have any questions answered and to make sure everything has returned to normal.
Each woman reacts differently following a termination of pregnancy but many will need emotional support as they come to terms with the results of their decision. For many women the decision will have been a very difficult one to make and they will have some regrets and will need time to recover from the situation in which they found themselves.
It is advisable not to use tampons immediately after the operation because of the risk of infection whilst the cervix is open and the womb is bleeding. External sanitary towels should be used instead. For the same reason it is best to avoid full sexual intercourse at least until the bleeding has stopped. The woman may also be advised to take showers instead of baths for a few days after the procedure. Other than these suggestions, she should try to return to all normal activities as soon as she feels able to.
What contraception can be used?
Contraception can be started immediately either by having a coil inserted at the time of the procedure or by starting to take the oral contraceptive pill straight away. Alternatively, the woman may wish to wait at least until she has had her first period before discussing the options with her physician or family planning clinic. However, it is worth noting that she is fertile from the moment the termination is completed and, since many unwanted pregnancies are the result of contraceptive failure, it is a good time to re-think which method is going to be the most suitable and reliable in future.
Aygestin (Norethindrone), Alesse (Levonorgestrel), Apri (Desogestrel), Ovral (Norgestrel)
Last updated 20 December 2011