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Abortion in the UK — A Practical Guide for PLAB 2 Candidates

Updated: Jun 26

Abortion is a commonly tested topic in PLAB 2, not only from a medical standpoint but also in terms of communication, ethics, safeguarding, and consent. As an IMG, it's vital to understand how abortion is approached legally, clinically, and compassionately in the UK.


⚖️ Legal Framework

  • Abortion is legal up to 24 weeks in England, Scotland, and Wales under the Abortion Act 1967.

  • After 24 weeks, it’s only permitted under specific circumstances:

    • Risk to the woman’s life

    • Severe fetal abnormalities

    • Grave permanent injury to physical or mental health

  • Two doctors must certify that the abortion meets legal criteria.

  • Patients can self-refer to abortion providers — no GP referral is mandatory.



🏥 Where Is Abortion Provided?

These services are free of charge under the NHS.



🧰 Services Provided by Abortion Clinics

Abortion providers offer a holistic package of reproductive health services, not just termination of pregnancy. These include:

✅ 1. Pregnancy Options Counselling

  • Non-judgmental discussion of options: continuation, adoption, or abortion

  • Emotional support and time to decide

✅ 2. Abortion Services

  • Medical and surgical abortion up to legal limits

  • Early Medical Abortion at Home (EMAH) if eligible

✅ 3. STI Screening and Treatment

  • Tests for chlamydia, gonorrhoea, HIV, syphilis (offered, not mandatory)

  • Treatment and partner notification if needed

✅ 4. Contraception Advice and Provision

  • Immediate access to all contraceptive methods: IUD, pill, injection, implant

  • Long-acting methods can be fitted during or after the procedure

✅ 5. Aftercare and Follow-up

  • 24/7 helplines for complications or emotional support

  • Advice on what to expect, warning signs, and recovery

✅ 6. Support for Vulnerable Groups

  • Safeguarding checks for minors, abuse survivors, trafficking victims

  • Mental health referrals or liaison with social services



🕒 Types of Abortion by Gestational Age

✅ Up to 9 weeks + 6 days

  • Medical abortion (mifepristone + misoprostol)

  • Can be taken at home under EMAH

✅ 10–14 weeks

  • Medical or surgical abortion (vacuum aspiration)

✅ 14–24 weeks

  • Usually surgical (D&E) or induction

  • Requires more monitoring

✅ Over 24 weeks

  • Only under strict legal grounds

  • Managed in specialist NHS units


🧪 Pre-procedure Assessments

  • Ultrasound scan to confirm gestation and location

  • Blood tests: haemoglobin, blood group, Rh status

  • Infectious disease screening (optional)

  • Safeguarding & medical history review



💉 Anaesthesia Options (Discussed in Advance)

Type

Used When

Risks

Local

Early abortion

Mild pain, rare allergic reaction

Conscious sedation

Up to 14–16 weeks

Drowsiness, nausea, rare breathing issues

General

Later gestation or patient preference

Anaesthetic risks, sore throat, rare complications

💊 Are Antibiotics Given?

Yes. Prophylactic antibiotics are standard before surgical abortion to reduce the risk of:

  • Endometritis

  • Pelvic Inflammatory Disease (PID)

  • Long-term fertility complications (rare)



❗ Risks & Fertility Impact

Surgical abortion is safe and typically has no effect on future fertility. However, rare complications include:

  • Infection (if untreated → PID)

  • Uterine perforation

  • Cervical trauma

  • Asherman’s Syndrome (intrauterine scarring)


All are rare and preventable with proper care and early treatment.

🧬 Post-Abortion Contraception

Fertility can return within 2 weeks, so contraception should start immediately. Clinics offer:

Method

When Offered

IUD/IUS

Inserted during surgical abortion

Implant/injection

Same day

Pill/patch

Immediately post-procedure


💬 GP/PLAB 2 Communication Approach


🔑 Key counseling points:

  • Respect privacy and autonomy

  • Confirm understanding and capacity

  • Explore emotional state and support systems

  • Provide clear, non-judgmental information

  • Offer self-referral or direct booking

  • Discuss risks, recovery, and contraception


🗣️ Example script:

"Abortion is a safe, legal option in the UK. We’ll support whatever decision you make and ensure you’re well informed, cared for, and offered full aftercare, including contraception."



📌 Takeaway for PLAB 2

  • Know the gestational cut-offs, self-referral options, and clinic services

  • Be clear on anaesthesia types, complications, and infection prevention

  • Practice empathetic communication and consent-taking in sensitive cases

  • Prepare to assess for safeguarding, mental health, and coercion


📚 References


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