Abortion in the spotlight

In this final issue of 2017, the 50th anniversary year of the passage through parliament of the UK Abortion Act, we make no apology for dedicating many of our articles to the topic of abortion, ranging from very early self-induced abortion as fertility control, through early first-trimester abortion, to mid-trimester abortion and then to post-abortion care.

In her Editorial, Mary Pillai refers to the article by Koh et al. (page 252) comparing three prostaglandin regimens for medical induction of mid-trimester abortion. While late abortion forms only a small proportion of the total number, its risks and complexity are greater than with early abortion. But the risks are dependent on the method used and there is evidence that the surgical approach to mid-trimester abortion using dilatation and evacuation (D&E) carries significantly fewer risks than the medical approach. She draws attention to the decreasing cohort of skilled D&E practitioners in the UK, such that in many cases women cannot be offered a choice between a rapid, safe and relatively pain-free abortion and a prolonged, riskier and undoubtedly painful and distressing experience. Training of a new cohort of doctors who are prepared to perform D&E is urgently needed. See page 249

Randomised controlled trial of second-trimester medical abortion methods

This important study by Koh et al. from Singapore compared three mid-trimester medical abortion regimens using misoprostol in two doses, and gemeprost, all without mifepristone. The main outcome measure was abortion within 48 hours of administering the first prostaglandin dose. The authors conclude that despite being licensed for this indication, gemeprost is no longer the best first-line treatment. Unfortunately completeness of abortion with the three methods could not be evaluated as local policy required routine surgical evacuation after abortion. See page 252

The legal argument supporting nurse and midwife-performed vacuum aspiration for induced abortion

Sheldon and colleagues present a cogent and persuasive argument that vacuum aspiration for abortion could legally be performed by nurses …