Makindo Medical Notes

💡 All aspects of abortion care should be delivered in a respectful, non-judgemental, and person-centred manner. 👩‍⚕️ Women and pregnant people are the decision-makers.

📖 About

• 📝 Legal framework: The Abortion Act 1967 (amended 1990) sets out the grounds for legal termination in England, Scotland & Wales (not NI).
• 📊 Prevalence: ~1 in 3 women will have a termination. Almost 200,000 occur each year in the UK; 99% are before 20 weeks.
• ⏱️ Timing: Most abortions occur in the first 9 weeks.

⚖️ Legal Grounds (UK, excl. NI)

• <24 weeks:
  • Risk to the woman’s life.
  • Risk to the woman’s physical or mental health (most common reason, >90%).
  • Risk to health of existing children.
  • Serious risk the baby will be severely handicapped.
• At any stage (including late pregnancy):
  • Real risk to the mother’s life.
  • Grave permanent risk to mother’s health.
  • Severe foetal abnormality.

⚠️ Seek medicolegal advice if patient is <16 years old or has impaired decision-making capacity.

🚫 Contraindications (Medical Abortion)

• Known or suspected ectopic pregnancy.
• Allergy to mifepristone or misoprostol.
• Severe uncontrolled asthma, chronic adrenal failure, porphyria.

🗣️ Counselling

• Ensure the patient knows they can change their mind at any time.
• Explore support, implications, and alternatives in a non-judgemental consultation.
• Allow time to reflect; GPs with ethical objections should refer promptly to another provider.

💊 Medical Management

• Before 12 weeks (can be home-based):
  • Day 0: Mifepristone 200 mg orally.
  • Day 1–2: Misoprostol 800 mcg vaginal, buccal, or sublingual. If no bleeding after 4 h, take extra 2 tablets.
  • Analgesia: e.g. codeine, NSAIDs.
• 12–24 weeks (usually hospital-based):
  • Day 0: Mifepristone 200 mg orally.
  • Day 1–2: Misoprostol 800 mcg, then 400 mcg every 3 h until expulsion.
• After 24 weeks (hospital-based):
  • Day 0: Mifepristone 200 mg orally.
  • Day 1–2: Misoprostol 100–400 mcg every 3–6 h (lower doses in late gestation).

🔪 Surgical Management

• <14 weeks: Vacuum aspiration (manual/electrical). Cervical prep with mifepristone or misoprostol.
• 14–24 weeks: Dilatation & evacuation (D&E) with cervical preparation. Requires experienced operators.

🦠 Infection Prevention

• Medical abortion: prophylactic antibiotics not required.
• Surgical abortion: antibiotics reduce infection risk (e.g. doxycycline 100 mg BD × 3–7 days, start within 2 h).

⚠️ Possible Complications

• Infection (often chlamydia-related).
• Incomplete abortion (1/100 cases).
• Excessive bleeding — may rarely need transfusion.
• Failed procedure (up to 14/1000 cases).
• Uterine perforation or cervical trauma (surgical).
• Psychological distress (variable, requires sensitive follow-up).

🧬 Anti-D

• Offer to all non-sensitised RhD-negative women from 12 weeks onwards (within 72 h).

💍 Contraception

• Can start immediately post-abortion: OCP, POP, IUCD, IUS.

📚 References

• RCOG Best Practice in Abortion Care (2022)