The first is medical induction of labour, typically using the drugs mifepristone and misoprostol to induce uterine contractions and cause the passage of the fetus and placenta intact. This can be a lengthy process: the mifepristone is administered 48 hours before admission, and the induction can take up to 24 hours and may require further surgery to remove retained tissue.
It will usually take place on a labour ward. The second option is surgical abortion, which involves instrumental removal of the fetus and placenta in small pieces through an artificially dilated cervix, under appropriate anaesthesia, typically taking minutes. This is done as an outpatient procedure 'day surgery' , and does not usually require admission to hospital.
Department of Health DH data from England and Wales show that surgical abortion is times safer than medical abortion in the second trimester. The higher rate of complications with medical induction is largely due to the significant minority of women who require additional surgery to remove retained tissue. This can also result in bleeding requiring blood transfusion. A US study by Bryant et al. The authors concluded that 'dilation and evacuation is significantly safer and more effective than labor induction for second-trimester abortion for fetal indications', and that 'Women facing this difficult decision should be offered a choice of methods and be provided information about their comparative safety and effectiveness'.
A randomised controlled trial by Kelly et al. A US literature review by Grossman et al. The authors recommended that a larger randomised controlled trial was needed, that 'directly compares outcomes between the two methods, examines acceptability to women and explores clinicians' perspectives on providing them. A US study by Whitley et al. In cases of termination for fetal anomaly, there are reasons why women might prefer either a surgical method, or medical induction.
For example, some women may prefer to go through labour and delivery, and have an intact fetus that they can see and hold. Others may find a surgical procedure under general anaesthetic easier to cope with.
For second-trimester terminations in general, research evidence strongly suggests that women have a preference for surgical procedures. Indeed one US trial comparing the two methods was unable to proceed because so few patients were willing to be randomised to the medical induction arm. When the termination is undertaken for fetal anomaly, the key factor is women's choice.
In , a qualitative study by Kerns et al of women terminating a pregnancy for fetal or maternal complications found:. Women's preferences for a method were largely based on their individual emotional coping styles. The lower acceptability rates of medical induction may be due to the fact that it takes significantly longer, is more painful and causes heavier bleeding.
Some women may also find the experience of labour extremely distressing in these circumstances. DH data show that that approximately three-quarters of all abortions done in the second trimester for indications not related to fetal abnormality are done surgically.
However, there is a lack of clear guidance as to which abnormalities benefit from detail fetal PM. It is unlikely to be of any benefit in the majority of anomalies.
Given the relatively small proportion of women who undergo surgical abortion for fetal anomaly, it has been hypothesised that clinicians have a bias against surgical abortion, despite it being safer and preferred by a majority of women.
More research is needed to confirm if this is the case, and is so, why. It is important that decision making about method of abortion for fetal anomaly should be shared between patients and clinicians, and both medical and surgical abortion should be offered wherever appropriate. However, the research is clear: surgical abortion is safer and preferred by most women.
It is therefore incumbent upon clinicians and commissioners to understand better why so few women in the UK with fetal abnormality undergo surgical abortion. Second trimester abortion for fetal abnormality. Robson in S. Second-trimester abortion for fetal anomalies or fetal death: labor induction compared with dilation and evacuation. Obstetrics and Gynecology. However, some studies have sought to assess particular aspects of the costs associated with raising and parenting extremely premature infants.
A study published in looked at the costs of caring for surviving newborns at weeks' gestational age in one university-based neonatal intensive care unit NICU over a month period from January through June The study did not include indirect costs, such as family expenses and lost income, nor did it include information on "long term costs of post discharge care" or "long term survival and morbidity.
Table 2. Source: K. Allen, B. Smith, I. Iliev, et al. Notes: " Administration and general" includes costs for marketing, provider tax, malpractice insurance, business office, registration, information technology, and hospital administration.
The above four studies describing the costs of the initial hospitalization of extremely preterm infants do not include the costs of follow-up health care and other services required after discharge from the NICU over the lifetime of the child. Because there are "increasing social and economic pressures to discharge preterm infants as early as possible" In addition, "former preemies have five times the rate of hospitalization of full-term babies during the first year of life.
In addition to the health care costs that extremely premature infants will generate post-NICU, other economic costs—such as day-care services, respite care, and school—are likely to exceed those of full-term babies.
Examples of other on-going economic expenses include travelling to and from medical and other special needs child-related appointments as well as lost parental earnings due to time away from work. These financial pressures and time constraints can have a lasting impact on the family and society as a whole.
Although a complete discussion is beyond the scope of this report, the care requirements—postdischarge—for an extremely premature neonate "far exceeds that of the NICU in both economic and non-economic terms.
Looking into the future lives of these children, a study in the United Kingdom and the Republic of Ireland examined spending in a variety of categories—hospital inpatient, outpatient, community health, drugs, education, additional family expenses, and indirect costs—over a month period.
The study involved a group of six-year-olds born extremely premature and a control group of six-year-olds born at full term. The study reported that the cost for children born at weeks' gestation ranged from two to six times more than for the control group of full-term infants. A study estimated the average lifetime costs of mild, moderate, and severe impairment associated with the resuscitation of infants at weeks and 6 days of gestation following either a preterm delivery or the termination of a pregnancy.
With more than 58, members, the American College of Obstetricians and Gynecologists ACOG is the specialty's "professional membership organization dedicated to the improvement of women's health. A human fetus does not have the capacity to experience pain until after viability. Rigorous scientific studies have found that the connections necessary to transmit signals from peripheral sensory nerves to the brain, as well as the brain structures necessary to process those signals, do not develop until at least 24 weeks of gestation.
In fact, the perception of pain requires more than just the mechanical transmission and reception of signals. Pain is "an emotional and psychological experience that requires conscious recognition of a noxious stimulus. The evidence shows that the neural circuitry necessary to distinguish touch from painful touch does not, in fact, develop until late in the third trimester. The occurrence of intrauterine fetal movement is not an indication that a fetus can feel pain.
The statement cites to two references on the issue of fetal pain. In reviewing the neuroanatomical and physiological evidence in the fetus, it was apparent that connections from the periphery [in the body] to the cortex [in the brain] are not intact before 24 weeks of gestation and, as most neuroscientists believe that the cortex is necessary for pain perception, it can be concluded that the fetus cannot experience pain in any sense prior to this gestation.
After 24 weeks there is continuing development and elaboration of intracortical networks such that noxious stimuli in newborn preterm infants produce cortical responses. Such connections to the cortex are necessary for pain experience but not sufficient, as experience of external stimuli requires consciousness. Furthermore, there is increasing evidence that the fetus never experiences a state of true wakefulness in utero and is kept, by the presence of its chemical environment, in a continuous sleep-like unconsciousness or sedation.
This state can suppress higher cortical activation in the presence of intrusive external stimuli. This observation highlights the important differences between fetal and neonatal life and the difficulties of extrapolating from observations made in newborn preterm infants to the fetus. The second source is a review published in JAMA. It concluded that "[e]vidence regarding the capacity for fetal pain is limited but indicates that fetal perception of pain is unlikely before the third trimester.
Pain perception requires conscious recognition or awareness of a noxious stimulus. Neither withdrawal reflexes nor hormonal stress responses to invasive procedures prove the existence of fetal pain, because they can be elicited by nonpainful stimuli and occur without conscious cortical processing [in the brain].
Fetal awareness of noxious stimuli requires functional thalamocortical connections [in the brain]. Thalamocortical fibers begin appearing between 23 to 30 weeks' gestational age, while electroencephalography suggests the capacity for functional pain perception in preterm neonates probably does not exist before 29 or 30 weeks.
In a commentary, a representative of ACOG stated that the JAMA review article "incontrovertibly found no existence of fetal pain until much later in gestation.
Importantly, no research since its publication has contradicted its findings. Tara C. Jatlaoui, Jill Shah, Michele G. Mandel, et al. Guttmacher is a research and policy organization committed to advancing sexual and reproductive health and rights in the United States and globally. The groups of women were recruited in a ratio of Gestational age limits at these clinics ranged from 10 weeks to the end of the second trimester; 16 sites had a limit beyond 20 weeks.
Authors of the Turnaway study state, "The account we have presented of women who seek later abortions is not meant to supersede consideration of the fetus in the abortion debate.
Rather, we are offering an important corrective to discussions that have conceptualized later abortions exclusively in terms of the fetus, without a portrait of the women seeking them. Anne R. Davis, Sarah K. Horvath, and Paula M. Gawron, Kenzie A. Cameron, Ava Phisuthikul, et al. Lori M. For an overview of state abortion-specific regulations that may affect safety and quality of abortion services, see Table on pages through Rachel K.
Jones and Jenna Jerman, "Characteristics of U. Patricia A. Lohr, Jennifer L. About 0. David A. The Cochrane Collaboration is an international network of over 37, contributors from more than countries, who prepare and update Cochrane Reviews. Cochrane Reviews provide evidence-based advice to help patients and physicians make well-informed health care decisions. Jenna Jerman and Rachel K. Joyce A. Martin, Brady E. Hamilton, and Michelle J. Osterman, et al. The NAS study notes that comparable data for other common medical procedures are difficult to find.
Suzanne Zane, Andreea A. Creanga, Cynthia J. Berg, et al. Ashok, A. Templeton, P. Wagaarachchi, et al. Goh and K. Table on pp. The authors note that exceptions "are limited and vary by state. They are often made for pregnancies resulting from rape or incest, pregnancies that endanger the woman's life or severely threaten the health of the woman, and cases of fetal impairment. Laura F. Harris, Sarah C. Roberts, M. Talk to the doctor or nurse at your hospital about your options.
It can help to talk. If your family and friends find it difficult to understand what you're going through, you could make contact with people who have had a similar experience. Antenatal Results and Choices can help. Visit healthtalk. Page last reviewed: 1 July Next review due: 1 July Home Pregnancy Support Back to Support. Termination for foetal anomaly.
Its helpline is answered by trained staff: Monday to Friday, 10am to 5. What happens There are 2 main types of termination: medical termination — taking medicine to end the pregnancy surgical termination — a procedure to remove the pregnancy You should be offered a choice of which method you would prefer whenever possible. Medical termination A medical termination involves taking medicine to end the pregnancy.
It involves the following steps: Taking a medicine to stop an essential pregnancy hormone. Without this hormone, the pregnancy can't continue. Usually 24 to 48 hours later, you have another appointment where you take a second medicine — either a tablet that you take by mouth or put inside your vagina.
You may need more than 1 dose. The lining of the womb breaks down, causing bleeding and loss of the pregnancy. This may take several hours.
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