The Royal College of Obstetricians and Gynaecologists has an e-learning module for abortion providers called ‘Making abortion safe’. In the related ‘Medical abortion from 12 weeks of pregnancy: Summary sheet’, it lays out some of the risks that providers need to be aware of for these later-gestation abortions, including a 1-in-7 risk of needing further medical intervention to complete the abortion.[i]
The RCOG warns abortion providers that the “uterus is more sensitive to misoprostol as pregnancy advances, and therefore, in pregnancies over 24-weeks, lower doses of misoprostol should be used and increased intervals between misoprostol doses should be considered, especially for women with uterine scars.” It states an initial dose of 400mcg of misoprostol, which is half the dosage used when gestational age is less than 12-weeks.
The medical abortion treatment is not always effective, there is a 13% risk of the abortion being incomplete, requiring further intervention to complete the procedure. This is more than twice the stated risk for women using pills-by-post under the 10-weeks limit, meaning that as many as 1-in-7 who self-manage their medical abortion from 12-weeks will need to seek medical intervention at their local A&E.
Women need to be informed, as part of the consenting process, that she might see the fetus and placenta and may see some reflex movements if she is more than 16-17 weeks pregnant.
From 22-weeks gestational age, feticide is recommended before using the abortion pills, to “avoid [the] fetus being born with signs of life, which can cause distress for women and their care providers.”
The World Health Organisation recommends feticide from 20-weeks.
Women who are self-managing their abortion will be unable to follow the RCOG best-practice of feticide when the gestational age is 22-weeks or more, they will see a fully-formed fetus, with possible signs of life, and might cause themselves unnecessary harm if using the full 1,200 mcg dose of misoprostol included in the pills-by-post package.
[i] Making abortion safe – summary papers (n.d.). RCOG. https://www.rcog.org.uk/about-us/global-network/centre-for-womens-global-health/our-approach/our-resources/making-abortion-safe/
Percuity 
Leave a comment