QuestionSBA
QuestionChoice
This is not an appropriate action to take as it goes against the patient's autonomy and confidentiality. In the United Kingdom, abortion is legal and whilst doctors are allowed to **conscientiously object**, it is not against our law and thus should not be referred to the police.
62254
b
Refuse termination of pregnancy and inform the police
QuestionChoice
The patient, in this case, is an 18-year-old female, which means she is a legal adult according to UK law and has the right to make her own healthcare decisions and provide consent for medical treatment. Informing her parents or seeking their consent is unnecessary in this situation, as the patient can understand the risks and benefits of the procedure and has clearly expressed her desire for an abortion. It is important for healthcare providers to respect the patient's autonomy and confidentiality in this situation, even if it goes against their personal beliefs or values.
62255
c
Refuse termination of pregnancy and inform her parents
QuestionChoice
Whilst termination of pregnancy is legal in the UK, doctors are allowed to refuse to offer this treatment if it goes agaist their personal values or belief. They **must** however refer patients seeking such interventions onto another doctor who can facilitate this. This is termed 'conscientious objecting'.
62257
e
Perform surgical termination of pregnancy
QuestionChoice
This is the most appropriate action to take in this situation as it respects the patient's autonomy and allows her to receive the care she desires while also acknowledging and respecting the healthcare provider's *conscientious objection*. **It is important to ensure that the patient's needs are met while also taking into consideration the healthcare provider's beliefs and values.** However, doctors are **obliged** to refer the patient on to an appropriate alternative, and cannot deny the care to this patient.
62253
a
Refuse termination of pregnancy and refer to your colleague to carry out the procedure
QuestionChoice
Whilst termination of pregnancy is legal in the UK, doctors are allowed to refuse to offer this treatment if it goes agaist their personal values or belief. They **must** however refer patients seeking such interventions onto another doctor who can facilitate this. This is termed 'conscientious objecting'.
62256
d
Perform medical termination of pregnancy
Concept
Chapter
# Summary 

Termination of pregnancy refers to deliberate process of ending a pregnancy. It may be legally performed for a number of reasons under the Abortion Act 1967, either medically or surgically. 

# Definition 

Termination of pregnancy refers to the deliberate medical process of ending a pregnancy so that it does not result in the birth of a baby. This can be achieved through medical or surgical means. 

# Legal Categorisation

In the UK, termination of pregnancy (TOP) is governed by the The Abortion Act of 1967. **There are five 'categories' for performing a TOP:**

A: An abortion is permissible if continuing the pregnancy would involve a greater risk to the life of the pregnant person than terminating the pregnancy.

B: An abortion is allowed if continuing the pregnancy would involve a greater risk of grave permanent injury to the physical or mental health of the pregnant person.

C: Termination is allowed if continuing the pregnancy would involve a greater risk to the physical or mental health of the pregnant person or any existing children of their family than terminating the pregnancy. This ground is most often used and is applicable up to 24 weeks of pregnancy.

D: An abortion is permissible if there is a substantial risk that the existing children of the family would suffer if the pregnancy were continued. This ground is applicable up to 24 weeks of pregnancy.

E: An abortion is permissible if there is a substantial risk that the fetus would be born with serious physical or mental disabilities. There is no time limit for abortions under this ground.



Additionally, there are two important sections for **emergencies**:

F: An abortion can be performed in an emergency if it is necessary to save the life of the pregnant person. This can be done without the need for approval by two doctors.

G: An abortion can be performed in an emergency if it is necessary to prevent grave permanent injury to the physical or mental health of the pregnant person. Similar to ground F, this can be done without the need for approval by two doctors.


**Important considerations:**

* Certification: Except in emergencies (grounds F and G), two doctors must agree and certify that at least one of the grounds for abortion (A-E) is met.
* Time Limits: Grounds C and D are only applicable up to 24 weeks of pregnancy, while grounds A, B, and E have no time limit.
* Consent: The pregnant person's consent is required, and they must be fully informed about the procedure and its implications.
* Location: Abortions must be carried out in an approved hospital or clinic.


# Medical Termination of Pregnancy (MTOP)

Usually facilitated with the use of :

* Mifepristone, a progesterone antagonist, blocks the progesterone required for continuation of the pregnancy. This is administered first (orally). 
* Misoprostol, a prostaglandin analogue. This causes smooth muscle contractions of the myometrium, resulting in expulsion of uterine contents. Misoprostol is administered 24-48h after mifepristone (also oral), and may be repeated 3-hourly (max 5 doses) until expulsion). 

Note: 

* For early pregnancies (0-9 weeks) this can be performed at home.
* For pregnancies around 9-24 weeks, perform in clinic.
* For later pregnancies (from around 22 weeks) may require feticide (intracardiac KCl injection) 


**Side effects and Complications:**

* Severe nausea
* Cramps 
* Diarrhoea
* Vaginal bleeding
* Incomplete termination of pregnancy: these cases then must be managed surgically

# Surgical Termination of Pregnancy (STOP)

Surgical management is the more effective option for larger pregnancies that may be further along in gestation. Surgical management may include: 

* Suction termination
* Dilatation and evacuation/curettage 'D&C'



**Side effects and Complications:**

* Retained products of conception
* Haemorrhage 
* Infection 
* Perforation 


# NICE Guidelines

[Click here for NICE Guidelines: Termination of Pregnancy](https://www.nice.org.uk/guidance/ng140/documents/draft-guideline)

# References

[British Pregnancy Advisory Service: Abortion Treatments](https://www.bpas.org/abortion-care/abortion-treatments/)

[The Abortion Act 1967](https://www.legislation.gov.uk/ukpga/1967/87/section/1)
2002
1115
Termination of pregnancy
Topic
26
Gynaecology
12512
An 18-year-old female who is 14 weeks pregnant has requested a termination of pregnancy as she is an emotionally abusive relationship and this is significantly affecting her mental health. She does not feel she would be able to raise this child. However, your religious belief does not align with the patient's intentions, and you do not wish to arrange the abortion.

What is the most appropriate action to take in this situation?
a