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Ensuring that women have access to safe abortion is “pro-life”

BMJ 2012; 345 doi: (Published 04 July 2012) Cite this as: BMJ 2012;345:e4391
  1. Alice Clack, specialist trainee year 6, obstetrics and gynaecology, Hillingdon Hospital, Uxbridge UB8 3NN, UK,
  2. Patricia Lledo-Weber, obstetrician and gynaecologist, Brussels, Belgium
  1. aclack{at}

I first met Nesta at about 2 am. She had been brought to the hospital late evening, confused, febrile, and hypotensive. I diagnosed septic shock, and we treated her with intravenous fluids and antibiotics. Initially, I was not too alarmed by the lack of urine in her bladder. This, I thought should remedy itself with our treatment. I was, however, uncertain about the history she insisted was hers. It is after all unusual practice to perform a dilatation and curettage for chronic pelvic pain. Still this was Liberia, and I’d seen far stranger.

By morning, and several litres of intravenous fluid and high doses of diuretic later, I was becoming more concerned about our failure to extract any of Nesta’s urine. She was increasingly confused, but still able to adamantly deny that she had had an abortion.

Being a pragmatist I washed out her bladder and thereby confirmed her pregnancy. Dilatation and curettage showed offensive products of conception, but her abdomen was soft with no evidence of a perforation. Fabulous.

It doesn’t matter how often you check, flush the catheter, or press on a patient’s bladder. If …

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