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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 surgical abortion is 6-11 times safer than medical abortion in the second trimester in England and Wales. 1 Although there are limitations to the statistics, the complication rates are in keeping with other reports, including randomised controlled trials, which show surgical abortion to be not only safer but more effective, cheaper, quicker, preferred by women, and associated with better emotional outcomes than medical abortion in the second trimester. 2 3 4 5 6 7 The difference in complications is largely due to the higher rates of retained tissue after medical abortion; the reported rates of this complication vary from 3% to...