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Case History

image A 21-year-old woman requests a pregnancy test. She normally has regular periods but this month her period is late and she has noticed some breast tenderness and nausea. She is very clear that she would not wish to continue with a pregnancy under any circumstances. An early morning sample of urine tested in the clinic confirms a positive pregnancy test.

What are the important questions to ask when taking a history?

What are the options for termination of pregnancy?

What are the important aspects of follow-up?


image Induced abortion or termination of pregnancy (TOP) is a very common gynaecological procedure. In the United States in 2003, 848 163 legal induced abortions were reported to the Centers for Disease Control and Prevention.1 According to the World Health Organization, in countries where induced abortion is permitted by law, which have total fertility rates of about 2 or less and high prevalence rates of contraceptive use, the annual rate of induced abortion is 1 to 2 abortions per 100 women of reproductive age.2 In countries with similar fertility rates but much lower prevalence of contraceptive use, the annual rate of induced abortion is higher and can be estimated to be up to 10 or more per 100 women annually. In countries where abortion is permitted by law, the large majority of abortions (typically >90%) take place before the end of the 12th week of pregnancy. Legislation about abortion varies throughout the world, may vary within different states of an individual country and may be illegal in some countries.1, 3, 4 The upper time limit for legal induced abortion also varies. In Europe it ranges from 12–28 weeks. The statutory grounds for TOP in England are detailed in Table 23.1. The legal time limit for abortion is 24 weeks for clauses C and D. However, abortions after 24 weeks are allowed if there is grave risk to the life of the woman, evidence of severe fetal abnormality, or risk of grave physical and mental injury to the woman (clauses A, B and E).

Table 23.1Statutory grounds for termination of pregnancy in England

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