Medical termination of pregnancy: when to use it and what does the law say about it?

L’medical abortion (IMG) is a medical procedure, the purpose of which is the termination of a pregnancy for medical reasons of the mother or the foetus. Authorized only by the pregnant woman or future parents and regulated by a medical certificate, it is generally performed when an anomaly of the fetus is detected. Also known as therapeutic abortionthe medical abortion is a legally strictly regulated process. In which cases is a medical abortion indicated? What is the procedure for an IMG? What does the law say about IMG?

Medical termination of pregnancy: indications

L’medical abortion (IMG) is recommended and practiced as part of the detection of a serious anomaly after prenatal diagnosis. It is practiced in particular when:

  • Pregnancy affects the health of the pregnant woman in danger ;
  • The unborn child is threatened with an incurable disease.

Regarding a IMG For fetal reasons, there is no complete list of diseases.

Today, medical abortion is rarely performed due to the health of the wearer. According to a 2012 report by the Multidisciplinary Centers for Prenatal Diagnosis (CNDPN), nearly 275 seem medical abortion were performed for maternal reasons, while about 7130 were performed for fetal reasons.

the IMG for fetal reasons affecting the genetic conditionsthe syndromes of malformationsthe chromosomal abnormalities and infections that are likely to be the cause of death of the baby in fetal condition or in the first years of life. When detecting certain diseases, such as trisomy 21, the survival of the baby is not taken into account.

In addition, a CNDPN report shows that more than 80% of IMGs are performed for chromosomal indications and malformation syndromes.

However, themedical abortion can be performed at any time with amenorrhea if the pregnant woman or the couple so wishes. However, this gesture necessarily requires authorization, issued by a multidisciplinary medical team.

Medical Abortion: What is the Upstream Process?

An IMG follows a set of mandatory steps.

  • A pathological assessment must first be carried out by the referring doctor. It takes into account themorphological ultrasoundAdditional examinations such asFetal MRIthe tests of serologyAmniocentesis etc., then further advice if necessary (referring psychiatrist, psychiatrist, geneticist)
  • Thus, only the couple or the patient can submit an applicationmedical abortion ;
  • Then the file is debated in the assembly of the CPDPN. The IMG protocol must be signed by an average of two doctors practicing at the center. This protocol must also be included in the medical record before the start of the procedure.

Finally, several interviews are conducted by the midwife and the doctor to provide answers to the concerns of expectant parents or pregnant women. In this one-to-one discussion, the following parameters in particular are discussed:

  • Practical modalities of medical abortion;
  • stop the fetal life (from the twenty-second week of amenorrhea);
  • feto-pathological examination;
  • ability to see the body;
  • choice to name the child;
  • Work stoppage or childbirth leave ;
  • Care of the corpse and execution of the funeral by the couple;
  • help from a psychologist;
  • advisory anesthesia ;
  • binding sheet with the request for fetal pathological examination and the morgue, which must be available beforemedical abortion ;
  • The application must be accompanied by a power of attorney for an autopsy signed by the doctor and the couple DNA samplesif necessary.

Medical abortion: how is it done?

The protocol (medical or surgical) for a IMG depends on the week of pregnancy and the history of the pregnant woman.

Pregnancy less than or equal to fourteen weeks

If the fetopathological examination is not strictly necessary (in case of a known chromosomal abnormality), the proposed protocol is a Surgical IMG. This happens through aspiration under ultrasound control and if necessary supported by the germ clipS. the neck of l’uterus is prepared by misoprostol in the evening of the previous day or in the morning of the day of the interruption. The preparation is made vaginally.

The pregnant woman is taken to the hospital on an empty stomach in the morning and comes out the same day in the evening. During the procedure, the patient is accompanied by a relative or family member.

If a fetopathological examination proves necessary, the following protocol should be followed: a medical img (based on medication), also called IMG by induced expulsion method.

Pregnancy longer than fourteen weeks

In this case we use mifepristone (three capsules to be taken once, forty-eight hours before the medical break) in preparation cervix. Hospitalization of the pregnant woman follows the same procedure as for amenorrhea less than 14 weeks ago (that is, in the morning and on an empty stomach).

A IMG practices after 14 weeks the pregnancy goes through the establishment of theepidural.

Pregnancy greater than or equal to twenty-two weeks

From the 22nd week of pregnancy:

  • You must do a fetal anesthesia through intracordonal injection from a milligram of midazolam Where from intracardiac, if access to the cable is difficult;
  • Then you have to make one intracordial injection of KLC Where from lidocaine too 1% ;
  • The induction of labor takes place with misoprostol (Cytotec for vaginal use);
  • Once the cervix has become permeable, the membranes must be ruptured as soon as possible;
  • In the event of the ineffectiveness of contractions after application Cytotec seven times it is necessary to infuse sulprostein.

In addition, as part of a scarred uterus, the procedure is the same (32 weeks ago). It is triggered via the come PGE2 and we continue with thatoxytocin.

Medical abortion: what needs to be done afterwards?

After an IMG, loc psychological support is systematically offered to the couple to allow them to go through the time of perinatal grief. In general, the pair a postnatal counseling, six to eight weeks after the break. This makes it possible to discuss a possible pregnancy plan with the couple and to define the precautionary measures.

At the request of the parents, the results of the fetopathological examination will be handed over and explained.

Medical abortion: What does the legislator recommend?

The IMG is a strictly regulated process governed by Article L2213-1 of the Public Health Code. It is therefore appropriate that the medical team follows the prescribed rules.

So by law a medical abortion is practiced under the condition that two doctors from a multidisciplinary group certify, after a diagnosis, that the continuation of the pregnancy poses a real risk to the pregnant woman and the child.

In the case of an IMG request based on the health of the surrogate, the team must consist of at least the following four people:

  • A doctor chosen by the patient;
  • A Obstetrician Gynecologistwho must be a member of a CPDPN;
  • A specialist in the disease the woman suffers from;
  • A psychologist or social worker.

In the case of a request for an IMG due to the child’s health, the CPDPN team must review the request. The mother-to-be has the opportunity to choose a doctor who will take part in the evaluation interview. Be that as it may, the decision of Practice of an IMG or not depends Patiently.

In addition, there are some rules that the multidisciplinary team must respect.

presentation of the body

In the delivery room, the obstetrician or midwife suggests that the patient or the couple look at the already washed and dressed body of the fetus. This step will be discussed with the couple in one or more sessions prior to the procedure.

The child’s body must be left in the delivery room for at least two hours. Then it is sent to the level of the morgue, accompanied by a request forautopsy (with parental permission) and the connection form.

Declaration of civil status

If the pregnancy medical procedure is performed before the 22nd week of pregnancy, the maternity give one birth certificatestating that the baby was born after a IMG. The certificate in question makes it possible to obtain a certificate from the town hall for a child born dead. From this point on, the child can be entered in the family book in the part reserved for the death. In addition, assigning a first name to the deceased baby is not mandatory.

When’medical abortion practiced after the 22nd week of pregnancy, the couple is obliged to declare the child as a civil status and to obtain a certificate of the stillborn child. In addition, you are not obliged to give him a first name in this case, and you also enter it in the booklet in the mortuary area.

social rights

Which social rights are granted depends on the duration of the realizationmedical abortion.

  • IMG 22 weeks ago amenorrhea: we do not assign maternity leavebut the woman has the option of taking a break from work (the duration is determined by the attending doctor or midwife);
  • IMG after 22 weeks: the patient is entitled to maternity leave and four months’ basic allowance. She is also entitled to childbirth benefits. The father can also take paternity leave.

body support

After the abortion, the couple is systematically offered an autopsy, but it remains optional. The main thing is that photos are taken in the morgue and are available to the couple.

  • As part of a stillborn fetus The care is arranged for over twenty-two weeks and the parents have the opportunity to carry out the funeral. The body can be entrusted to the hospital: no earlier than ten days after delivery, a cremation intended to give the couple time to think about what they want to do with their child’s body;
  • In the case of a fetus of less than twenty-two weeks, the declaration made at the level of the register of the town hall authorizes the closure of the coffin.

Medical abortion: rules for minors

  • case of unemancipated minor woman : Consent from a parent or representative must be obtained prior to interruption.
  • If the woman unemancipated minor wants to keep the secret, the doctor must obtain his/her consent for the legal representative or a guardian to be consulted, or examine the feasibility of this procedure.

In the event that consent is not obtained or if the non-emancipated minor does not wish to carry out the procedure, the medical interruption of the pregnancy and medical care and actions taken at their request. The underage woman can be accompanied by an adult of her choice throughout the entire process.

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