AKT · Obstetrics & gynaecology/Gynae oncology & screeninglow yield

Termination of pregnancy

Abortion Act 1967 framework

Overview

Legal ending of pregnancy under the Abortion Act 1967 (two doctors’ agreement; commonly under 24 weeks for risk to physical/mental health). Provided medically (mifepristone + misoprostol) or surgically; anti-D for rhesus-negative women in some circumstances.

Recognise

Medical: mifepristone (anti-progesterone) then misoprostol (prostaglandin)
Surgical: vacuum aspiration (≤14 weeks) or dilatation & evacuation
Pre-procedure counselling, contraception planning

Red flags

Haemorrhage, sepsis (retained products), uterine perforation

Differentials & how to tell them apart

Miscarriagespontaneous loss — different pathway

Ectopic pregnancymust exclude before medical TOP

Investigations

Confirm pregnancy/dating (USS), screen STIs, rhesus status, contraception discussion.

Management

Mifepristone then misoprostol (medical); vacuum aspiration (surgical)

1Medical (any gestation): mifepristone then misoprostol. Surgical: vacuum aspiration (≤14 weeks) or D&E.Gate: Give anti-D immunoglobulin to rhesus-negative women (per gestation/method guidance)
2Offer contraception (can start immediately, incl. LARC); STI screening; follow-up to confirm completion.

Mifepristone + misoprostol — medical regimen

Anti-D immunoglobulin — for rhesus-negative women (esp. surgical / later gestation)

Key points

Two registered doctors must agree (Abortion Act 1967). Always exclude ectopic before medical TOP. Start contraception at the time.

Monitor & prognosis

Completion (bleeding/βhCG), contraception uptake, complications.

Safe with low complication rates.

Source: NICE NG140; RCOG; Abortion Act 1967