A 33-year-old para 2+1 attends your clinic to discuss her positive pregnancy test. She has 2 children aged 6 and 10 years and had a STOP when she was 20 years old. She is in a fairly new relationship and feels it is not stable enough for a baby. She says she couldn’t support a baby by herself financially. She has a history of anxiety and depression and feels that she could not cope with continuing this pregnancy.
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1. What issues do you explore?
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Correct answer:
Confirm the pregnancy (if indicated) and estimate the gestation
Explore the options for an unplanned pregnancy namely – continue and keep the baby; continue with the pregnancy and place the baby for adoption; or terminate the pregnancy with an abortion.
Ask if her partner of anyone else knows about the pregnancy and if she has any support. Ask about her existing views about abortion. Discuss possible agencies who could offer her practical support or further counselling.
A clinical history should be taken to assess medical suitability should she choose an abortion.
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2. You estimate she is about 6 week’s gestation. She decides to take a few more days to think about her options. She reattends 3 days later requesting referral for an abortion. What are the legal requirements for abortion in the UK?
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Correct answer: Abortion in the UK is governed by the Abortion Act 1967, which allows abortion up to 24 weeks gestation if certain criteria are met (see Chapter 43, Abortion 1). She would be eligible for abortion, provided two doctors form the opinion in good faith that one of the clauses for abortion is met. Given her history Cause C would be the most appropriate.
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3. She attends the assessment clinic at the local abortion service and a scan confirms that there is a viable pregnancy of 7 weeks’ gestation. What are her options for the abortion procedure?
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Correct answer: She could have a medical or surgical abortion. The surgical abortion could be undertaken using vacuum aspiration (usually under general anaesthetic) or she could have an MVA procedure under local anaesthetic.
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4. She chooses an MVA procedure under local anaesthetic. What investigations are appropriate prior to the procedure?
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Correct answer: Her rhesus status should be determined. STI screening for chlamydia +/-gonorrhoea is recommended as is serology for HIV testing. Other investigations may be indicated depending on the clinical history or risk assessment.
Abortion spread 1 lists pre-abortion investigation.
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5. She wishes an LNG-IUS for contraception. When can this safely be inserted?
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Correct answer: It is safe and appropriate to insert an intrauterine device at the time of the abortion. It will be immediately effective if inserted at this time.
