Acne or pimples is a skin condition that usually affects adolescents or teenagers but may affect an individual at any age. It leads to spots and boils over the skin of the face, forehead, neck, back and chest.

The spots may range from blackheads and whiteheads that are mild and painless to severe boils or pustules that are inflamed and pus-filled with intense pain.

What is a termination of pregnancy?

A termination of pregnancy is when a pregnancy is ended intentionally. It is often referred to as an ‘abortion’ – although doctors use the word abortion to mean any pregnancy which ends before 24 weeks gestation whether intentionally or because of a miscarriage.

Before 1967 it was illegal to terminate a pregnancy but this resulted in women having illegal so-called ‘back street’ abortions which often posed a serious risk to their health because the methods used and the standard of cleanliness were both unpredictable and very poor. The 1967 Abortion Act which covers England, Scotland and Wales but not Northern Ireland, allowed pregnancies to be terminated legally under certain circumstances (see below) and in 2008 there were 195,000 terminations of pregnancy. [1] The most common age for a termination to be done in the UK is 19 and the under 18 rate is around 19 per thousand women which is one of the highest in Europe.

Other than in exceptional circumstances the legal upper time limit for a termination to be done is 24 weeks gestation.

Why is a termination done?

The 1967 Abortion Act allows termination before 24 weeks gestation to be done if:

• The pregnancy poses a threat to the life of the mother.
• The pregnancy may seriously affect the mother’s physical or mental health.
• The pregnancy may seriously affect the lives of the mother’s existing children.
• There is a significant risk of the resulting baby being abnormal.

Most terminations are performed under the second of the criteria above. There is no upper limit on the gestational age if there is:

• Risk to the mother’s life.
• Risk of grave, permanent injury to the mother’s physical or mental health. (allowing for reasonably foreseeable circumstances)
• Substantial risk that, if the child were born, it would suffer such physical or mental abnormalities as to be seriously handicapped. These terminations must take place in an NHS hospital.

Less than one percent of terminations take place after 20 weeks of gestation.

Two doctors must sign a form confirming that they feel that the termination fulfils the criteria and that they feel the termination should go ahead.

What choices are available?

Most women who are considering a termination will have confirmed that they are pregnant by doing a pregnancy test, either a home test bought from the chemist or one organised by their GP. The majority will discuss the options with their GP although some will go to a recognised private clinic. The doctor will establish how many weeks the pregnancy is and will try to help the woman to come to the right decision for her whether it be to continue with the pregnancy and either keep the baby or have it adopted or the termination the pregnancy. Occasionally an ultrasound scan is performed to establish the duration of gestation of the pregnancy if the mother is unsure of the date of her last period.

If the woman decides to have the pregnancy terminated she will then be referred to a gynaecologist either privately or under the NHS for the procedure to be done. The gynaecologist will often see the woman as an out-patient to go through the reasons for requesting the termination and to discuss the possible risks before going ahead with the termination.

What methods are available for termination of pregnancy?

If the pregnancy is less than seven weeks’ gestation the woman will almost certainly be offered something called a ‘medical abortion’. This involves giving the woman a tablet called mifepristone followed 36 to 48 hours later by a vaginal pessary. The tablet induces the abortion and the pessary causes contractions of the womb resulting in a kind of labour to expel the pregnancy. This is generally a very safe, effective method with no risks for future pregnancies. [2]

Between seven and twelve weeks the termination is usually performed by a method of suction evacuation. This involves either local or general anaesthetic being administered and then the neck of the womb (the cervix) being dilated using a special instrument. A plastic suction tube is then inserted into the womb and the contents of the womb including the pregnancy is sucked out. This is generally called a ‘surgical termination’.

Above a gestation of 12 weeks some gynaecologists may still use a surgical suction termination, usually after the administration of a pessary to soften and prepare the cervix. However, the greater the gestational age after 12 weeks, the more likely a certain type of medical termination is likely to be offered. As with early termination this involves the woman taking a mifepristone but this is then followed 36-48 hours later by pessaries administered every 3 hours to induce a kind of labour so that the foetus is expelled.

What are the possible risks and complications of a termination?

Terminations, especially those done before 12 weeks of pregnancy, are generally very safe and have a low complication rate. The two most common complications are infection and failure to completely empty the womb. Both of these can cause prolonged heavy bleeding in the days following the procedure so if this occurs, medical advice should be sought. Infection is treated with antibiotics whereas incomplete removal of the womb contents requires a D and C (dilatation of the cervix and curettage – scraping out – of the contents). Many gynaecologists will prescribe antibiotics to all women following a termination in order to prevent any subsequent infection.

Other complications include perforation of the womb with the suction instrument and trauma to the neck of the womb, the cervix, which may lead to a risk of miscarriage in later pregnancies because of what is called an incompetent (weak) cervix. Later abortions have a higher complication rate; roughly double that of earlier ones.

There is no conclusive proof that having an abortion affects future fertility but if an infection follows the procedure this may cause damage to the fallopian tubes (the tubes which carry the egg from the ovary to the womb) which could lead to fertility problems. The death rate from having an early abortion is about 1 in 100,000 in the UK which is very low and is about eight times less than childbirth itself.

A proportion of women experience long-term psychological problems from their decision to have a termination, sometimes resulting in post-natal depression in subsequent pregnancies. However, there is also some evidence of psychological after-effects in women and their baby who have been persuaded against their wishes, to continue with a pregnancy.

What happens after a termination?

After an early termination the woman will wake up in the recovery room outside the theatre and, once she has fully recovered, will be allowed home the same day unless there are complications. It is advisable that another adult stays with her the first night after the procedure in case she feels unwell or starts to bleed heavily.

Vaginal bleeding similar to a period should stop after a few days although it may take longer after a late termination and the first period should occur about four weeks later. Medical advice should be sought if the bleeding becomes heavy, prolonged or painful as this may be a sign of infection or incomplete emptying of the womb.

Return to work is usually possible after 48 hours. It is often suggested that the woman makes an appointment for a check-up with her doctor two to six weeks after an abortion to have any questions answered and to make sure everything has returned to normal.

Each woman reacts differently following a termination of pregnancy but many will need emotional support as they come to terms with the results of their decision. For many women the decision will have been a very difficult one to make and they will need some time to recover from the situation in which they found themselves. A list of organisations which offer such support and counselling before and after a termination of pregnancy are listed at the end of this factsheet.

It is advisable not to use tampons immediately after the procedure because of a slightly increased risk of infection whilst the cervix is open and the womb is bleeding. External sanitary towels should be used instead. For the same reason it is best to avoid sexual intercourse at least until the bleeding has stopped. The woman may also be advised to take showers instead of baths for a few days after the procedure. Other than these suggestions, she should try to return to all normal activities as soon as she feels able to.

What contraception can be used?

Contraception can be started immediately either by having a coil inserted at the time of the procedure or by starting to take the oral contraceptive pill straight away. Alternatively, the woman may wish to wait at least until she has had her first period before discussing the options with her GP or family planning clinic. However, it is worth noting that she is fertile from the moment the termination is completed and, since many unwanted pregnancies are the result of contraceptive failure, it is a good time to re-think which method is going to be the most suitable and reliable in future.

Where can further information be obtained?

Apart from contacting your GP or local family planning clinic, the following organisations may be able to offer further help.

British Pregnancy Advisory Service
BPAS Head Office
4th Floor
AMEC House
Timothy’s Bridge Road
Stratford Upon Avon
CV37 9BF
Telephone: 0845 7304030 (adviceline)
Website: www.bpas.org.uk

Brook (Previously Brook Advisory Service)
421 Highgate Studios
53-79 Highgate Road
London
NW5 1TL
Telephone: 0207 7950 7700 (24hr Info Line)
0207 284 6040
Email:admin@brookcentres.org.uk

This material has been prepared with specialist knowledge and medical experience and to the best of our knowledge and belief is current at the date of access to the AXA PPP healthcare website. Your doctor will be able to give you advice tailored to your particular treatment needs. Our material should be used for information purposes only. It is not intended to replace qualified medical advice nor should any information provided by Health at Hand be used for self diagnosis or treatment. For treatment or medication you should consult your doctor.

References:
1. Department of Health (2008). Abortion statistics, England and Wales, DoH
2. Virk J., Zhang J., Olsen J.(2007). Medical abortion and the risk of subsequent adverse pregnancy outcomes. New England of Medicine. Aug 16; 357 (7): pp 648-53


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