Pathophysiology

• Unplanned pregnancies are associated with poorer outcomes for mother and baby than if intended/planned
• 30-40% of unintended pregnancies end in abortion

Investigations

Estimation of gestation

• Clinical:
  • Estimated by LMP +/- date of positive UPT
  • Palpable uterus (> 12 weeks)
• Ultrasound:
  • Abdominal or transvaginal (> 6 weeks)
  • Frequently used for all pre-COVID
  • Now via risk assessment - symptoms/risk factors of ectopic, uncertainty about dates, before surgical termination

Management

Legal aspects of abortion

• Abortion is certified under HSA1 form
• Clause C - up to 23+6 weeks
  • 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
• Clause E - no gestational limit
  • There is substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped

Methods of abortion

• Medical - mifepristone PO, then misoprostol PO 24-48 hours later
• Surgical - < 14 weeks electric (GA) or manual vacuum aspiration (LA), > 14 weeks dilation and evacuation
• Choice depend on gestation, patient preference and regional avaliability

Prophylaxis at time of abortion

• Antibiotic prophylaxis given to those undergoing STOP and those undergoing MTOP with increased risk of STI
• Rhesus iso-immunisation
• VTE prophylaxis
  • Risk assessment - if high risk, consider LMWH 1/12 weeks after abortion
  • Women at very high risk may be started on LMWH before the abortion +/- continue for longer