B13. Legal regulation of pregnancy interruption, methods and complications

Legal stuff

Pregnancy may be terminated at the woman’s will, although the exact terms for who this is possible for and when this can occur varies wildly from country to country.

In Hungary, a pregnancy can be terminated up to the 12th week for any reason. However, the woman must go to a “Family Planning” committee to get permission for the abortion. She must bring a letter from an obstetrician which confirms the pregnancy. She must attend the committee twice (with three days in between) to receive information about state support and adoption (as well as to be lied to, berated, humiliated, and emotionally blackmailed). Pregnancy termination up to the 24th week is legal if severe foetal abnormalities are suspected. Termination is legal for the whole pregnancy in case the mother’s life is in danger, or if it’s determined that the foetus would be unable to survive.

Methods of induced abortion

Induced abortion may be achieved pharmacologically or surgically. However, in some countries (like Hungary), only surgical abortion is legal.

Pharmacological abortion

Pharmacological evacuation involves giving medications to terminate the pregnancy, stimulate cervical opening, and to stimulate uterine contractions. The process begins on day 1, where the patient has an appointment with an obstetrician to talk about medical history, decide on the method of abortion, etc.

One drug is given on day 1, followed by another drug on day 3. The patient may be admitted into the hospital ahead of the second dose to complete the abortion there, or they may take the second dose at home and complete the abortion there. After this second dose, the uterine contents are rejected.

The first medication given (on day 1) is usually an anti-progestin (mifepristone). This terminates the pregnancy and stimulates cervical opening. Then, on day 3, the second medication is taken. This may be a prostaglandin (misoprostol), or oxytocin. This stimulates uterine contraction and therefore rejection of the contents. Multiple doses of prostaglandin or oxytocin may be necessary to initiate the rejection process.

Symptoms include nausea, vomiting, diarrhoea, and abdominal pain, but these are self-limiting and easily managed with prophylactic analgesics and antiemetics. Complications are rare. Potential complications include haemorrhage, infection, or incomplete abortion. In rare cases, the pregnancy may be ectopic but not recognised as such during the examination. However, attempting pharmacological abortion of an ectopic pregnancy is rarely dangerous.

Surgical abortion

Surgical evacuation involves dilatation and curettage followed by suction of uterine contents by vacuum aspiration. Like pharmacological evacuation, it begins with an appointment with an obstetrician. Together, they find a date some days ahead to undergo the procedure. The procedure is usually a day case surgery (outpatient surgery).

The procedure is done under general anaesthesia or paracervical block. Hegar dilators are used to dilate the cervix. The uterine contents are thereafter aspirated. Following aspiration, the contents must be examined to make sure that everything was evacuated.

Prostaglandins should be administered ahead of the procedure to ripen the cervix in nulliparous women, as this makes the procedure easier. Patients should receive antibiotic prophylaxis to prevent postabortion endometritis.

Possible complications include infection, haemorrhage, cervical laceration, uterine perforation, and retained parts of the pregnancy.