Abortion: law, procedure, process… 7 questions about medical termination of pregnancy

7 questions about medical termination of pregnancy

In France, nearly 6,000 medical terminations of pregnancies – or therapeutic abortions – are carried out each year. They can be carried out when the pregnancy endangers the health of the woman or when the unborn child is in danger.

What does the law say ?

The IMG is governed by article L2213-1 of the Public Health Code. "The medical termination of a pregnancy can, at any time, be carried out if two doctors certify , after examination and discussion, that the continuation of the pregnancy seriously endangers the health of the woman or that there is a strong probability that the unborn child will be affected by a health condition ;a particular severity recognized as incurable at the time of diagnosis", we read in the text of the law.

When is an IMG considered ?

In children, fatal illnesses in the perinatal period or in the first year of life or illnesses leading to serious, sometimes fatal, disability may motivate an IMG. These are particularly serious diseases, whether genetic, infectious or malformative, diagnosed by ultrasound and/or various biological analyses.

In 10 to 20% of cases, the request for IMG is made in connection with a serious risk to the mother's health if the pregnancy continues.

When can an IMG be performed ?

L’IMG can be performed at any time during pregnancy. Unlike voluntary termination of pregnancy, there is no deadline to respect. As a reminder, this is 14 weeks of pregnancy for an abortion.

What is the procedure ?

When the diagnosis is made and an IMG is considered with the agreement of the mother or parents, the procedure depends on the reasons for the IMG: is the request justified for the health of the mother or that of the fetus ?

For the latter, the mother's request is examined by the medical team of a multidisciplinary prenatal diagnosis center, made up of a gynecologist, a specialist in neonatal pediatrics, a specialist in fetal ultrasound, a specialist in medical genetics.

When the mother's health is at stake, the request is examined by a multidisciplinary team, composed of at least:

a gynecologist who is a member of a multidisciplinary prenatal diagnosis center; a doctor chosen by the pregnant woman; a psychologist or social worker bound by professional secrecy; from a doctor specializing in what the woman is suffering from.

As soon as two doctors consider that the risk is justified, they draw up the certificates to justify the IMG. The mother must receive complete information and give her consent.

What is the prior consultation for ?

Once the certificates have been issued, the pregnant woman is given a preliminary interview by a doctor. The patient is informed about the progress of the IMG, the methods and products used, the duration of hospitalization, the possible risks and complications (hemorrhage, infections, uterine rupture). She is also offered psychological support which can help her overcome this ordeal, provide her with advice on breaking the news to her children, and facilitate the work of perinatal mourning…

How does the IMG take place ?

The IMG takes place within the framework of hospitalization. The IMG method used aims to obtain the expulsion of the fetus as quickly as possible in order to minimize the physical and psychological suffering for the mother.

Several criteria are taken into account to decide on the method: the term of the pregnancy, the state of health of the mother, her gynecological and obstetrical history, possible contraindications . Most often, childbirth is triggered by a medicinal technique. An epidural, and a preanesthetic consultation, can thus be scheduled.

If the medical technique fails, a surgical IMG technique can be considered. There are two:

Suction curettage; The evacuation of uterine contents after dilation of the cervix.

If the term of pregnancy exceeds 22 weeks of amenorrhea, feticidal anesthesia is recommended to avoid any pain. "Protocols vary greatly from one team to another. Most often, this consists of injecting an anesthetic or analgesic drug into the umbilical cord then a feticidal drug (leading to the death of the fetus)", details Ameli.fr.

What happens after an IMG ?

Maternity leave is provided if the fetus has died after 22 weeks of amenorrhea or the birth weight is at least 500 grams. Otherwise, the mother will benefit from sick leave, the duration of which will be determined by her doctor.

Psychological follow-up is offered and a consultation, preferably with the doctor who carried out the intervention, is scheduled. "It allows in particular to present the results of examinations carried out on the fetus, to take stock of the state of physical and psychological health of the woman and of the possible risks for a subsequent pregnancy", note Ameli.fr.