Analysis

Second trimester abortion for fetal abnormality

BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f4165 (Published 03 July 2013) Cite this as: BMJ 2013;347:f4165
  1. Richard Lyus, doctor 1,
  2. Stephen Robson, professor of fetal medicine 2,
  3. John Parsons, retired consultant gynaecologist 1,
  4. Jane Fisher, director 3,
  5. Martin Cameron, consultant in fetal medicine4
  1. 1British Pregnancy Advisory Service, Richmond TW1 2AR, UK
  2. 2Newcastle University, Newcastle upon Tyne, UK
  3. 3Antenatal Results and Choices, London, UK
  4. 4Norfolk and Norwich University Hospitals, Norwich, UK
  1. Correspondence to: R Lyus Richard.lyus{at}bpas.org
  • Accepted 30 May 2013

Although surgical abortion is safer and preferred by many women, most abortions for fetal abnormality in England and Wales are performed medically. Richard Lyus and colleagues call for an end to this disparity

Antenatal testing for fetal abnormalities is offered to all pregnant women in the United Kingdom, but most abnormalities are not detected until after 14 weeks of pregnancy. When an abnormality is detected a woman may choose abortion, which can be performed by either surgical or medical methods. Surgery is safer and preferred by women in the second trimester. Despite this, most abortions in the UK for fetal abnormality are medically induced. This disparity between evidence and practice needs to be investigated to ensure all women choosing abortion have access to the best available treatments.

Screening for abnormalities and options for abortion

Screening for fetal abnormalities using ultrasonography or biochemical tests allows patients and clinicians to plan appropriately for the delivery or consider the option of abortion. Each year in England and Wales at least 2000 abortions for fetal abnormality are recorded. About a third of these cases are for chromosomal abnormalities, of which trisomy 21 (Down’s syndrome) is the most common, and half are for structural abnormalities detected by ultrasonography, mainly affecting the nervous or musculoskeletal system.1 Screening tests for Down’s syndrome are offered at 11-14 weeks of pregnancy, and a detailed ultrasound examination of the fetus at 18-20 weeks. As a result, most fetal abnormalities are not diagnosed until the second trimester, when there are two options for abortion. Medical abortion, typically with the progesterone antagonist mifepristone and prostaglandin analogues, can take up to 48 hours and may require further surgery to remove retained tissue. The second option is surgical abortion (dilation and evacuation), which typically takes 10-15 minutes.

Evidence for choosing surgical abortion

Department of Health data on complications show that …

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