Medical abortion, which can be carried out right up to the end of the pregnancy when an abnormality is detected in the foetus, is the choice of the pregnant woman, after being accepted or proposed by the medical profession. In what cases can IMG be carried out? How are abnormalities detected? What is the procedure? Elia explains.
What is a medical termination of pregnancy?
A medical termination of pregnancy (or IMG) is defined as the cessation of a of the pregnancy when continuing the pregnancy poses a risk to the health of the mother or fetus. This is particularly the case when the unborn baby presents serious anomalies (physical and/or mental handicap) that would make its existence difficult or hinder its survival.
This is a termination of pregnancy for medical reasons, which can be carried out at any time during gestation. The final decision rests with the pregnant woman or her parents, and generally follows a proposal by the medical team. The decision to undergo IMG is often made following an ultrasound or amniocentesis, during which a serious illness in the fetus is discovered.
Formerly known as therapeutic abortion, this procedure nevertheless requires careful consideration of the pros and cons.
When is a medical abortion possible?
Medical termination of pregnancy is not a decision to be taken lightly: it is the result of medical circumstances that make it difficult, if not impossible, for the child to be born. There are several possible reasons for an abortion:
Fetal malformations and anomalies
IMG is performed when the fetus presents physical or mental abnormalities likely to hinder its survival or complicate its existence. The law is very clear on the subject, specifying that this procedure can be carried out if "there is a strong probability that the unborn child will suffer from a particularly serious condition recognized as incurable at the time of diagnosis". This could be a chromosomal abnormality such as trisomy 21, a genetic pathology leading to a hereditary disease , or a foetal malformation such as spina bifida (an abnormality in the closure of the foetal neural tube).
Dangers for the pregnant woman
IMGs due to danger to the mother's health are rare, accounting for only 5% of cases. This procedure is justified, for example, if the pregnant woman has cancer requiring radiotherapy. As this type of treatment is dangerous to her health, it is obvious that continuing the pregnancy at the same time is incompatible. This is also the case for multiple pregnancies, which may justify a partial voluntary termination of pregnancy.
If IMG is requested because of a health problem, the multidisciplinary team in charge of the case must be made up of a doctor qualified in gynecology-obstetrics, a member of a prenatal diagnosis center, a practitioner specializing in the disease in question, a doctor or midwife and a qualified person such as a social worker or psychologist.
How do you detect a high-risk pregnancy or fetal anomaly?
A pregnancy is considered to be at risk for the mother's health, particularly if she has a serious illness that is incompatible with pregnancy.
More specifically, multiple pregnancies can be considered "at risk" (this is the case when the expectant mother carries at least three fetuses in her womb) . The multiple nature of the pregnancy may present a risk, in which case a voluntary partial abortion can be performed before the end of the 12th week of gestation. This decision requires the agreement of two doctors, on the advice of the multidisciplinary team at the prenatal diagnosis center that received the mother's request.
The team may call in a psychiatrist or psychologist to take into account the woman's psychological condition, which may also play a role in favor of the termination. Criteria relating to the characteristics of the embryo or fetus (e.g. sex) cannot be taken into account for this partial termination.
Fetal anomalies are generally detected by ultrasound or amniocentesis, or by biological analysis of various samples (chorionic villi, fetal blood, mother's blood, etc.).
What is the time limit for IMG?
Unlikeabortion (voluntary interruption of pregnancy)IMG can be performed at any time during gestation, even up to term.
Article L2213-1 of the French Public Health Code states that IMG may be carried out "at any time, if two doctors who are members of a multidisciplinary team attest, after this team has issued its advisory opinion, either that the continuation of the pregnancy poses a serious threat to the woman's health, or that there is a strong probability that the unborn child will suffer from a particularly serious condition recognized as incurable at the time of diagnosis".
The absence of a time limit means that parents or mothers can take the time they need to reflect and make an informed decision, without rushing! To help them, they can consult specialists such as child surgeons, neuropediatricians, geneticists or pediatricians, so as to be aware of the concrete consequences should the child be born.
What techniques are used to terminate a pregnancy?
Medical abortion can be performed either medically or surgically. Here's how.
Medical abortion
If the pregnancy is terminated before 24 weeks of amenorrhea (i.e. 24 weeks after the start of the last menstrual period), anti-progestogen medication is used. Approximately two days after the first dose, the pregnant woman is given prostaglandins, which cause uterine contractions, cervical dilation and finally expulsion of the embryo. An epidural anesthetic is available to avoid the pain of contractions and expulsion.
Surgical abortion
Surgical termination is recommended after the 24th week of pregnancy, for the simple reason that after this time, there is a risk that a medicated expulsion will not work, leading to expulsion of a fetus that is still alive. It is obviously desirable to end the life of the fetus in utero.
In this case, the doctor performs what is known as foeticide, by injecting a product directly into the umbilical cord, through the woman's belly (an anesthetic or analgesic product, followed by a foeticidal drug). Once this operation has been performed, the medical team proceeds with a surgical technique such as curettage (aspiration), or a Caesarean section.
What is the IMG procedure for a minor girl?
In the case of a minor, the prior consent of the parents or legal guardian is required before the operation can be carried out. If, however, the pregnancy was kept secret by the minor, and she does not wish her parents to be informed, she can still obtain the doctor's consent, provided she is accompanied by the adult of her choice.
After the IMG: how can I get psychological support?
Obviously, the decision to terminate a pregnancy can have serious consequences for the psychological state of the mother and/or parents . Giving birth to a child is an adventure full of emotions and hopes, and choosing to put an end to it can be a real wrench.
That's why it's essential to make sure you have the support of family and friends, as well as qualified professionals, to listen to the needs of the couple going through this ordeal. It is often advisable to turn to psychologists or psychiatrists, who can be suggested by the multidisciplinary team in charge of the procedure. Our advice: turn to the Petite Emilie association, which supports people facing an abortion.
Medical termination of pregnancy in France: a few figures
- Trisomy 21 is one of the medical reasons accepted by law for medical termination of pregnancy (IMG);
- Around 7,000 terminations are performed each year in France;
- In 80-90% of cases, the reason for termination is related to a fetal anomaly: 43.5% of terminations are carried out following diagnosis of fetal malformations, 33.8% following diagnosis of a chromosomal anomaly, 12.3% for other fetal indications, 5.8% for genetic pathologies and 0.8% for infections.
Medical abortion FAQ
How does a medical abortion work at 6 months?
After 6 months of pregnancy, surgical intervention is recommended, as abortifacient drugs may not work. For those over 15 weeks of amenorrhea, the woman receives treatment to prevent the milk coming in, and psychological support is systematically offered to the mother and the couple to help them overcome this ordeal.
What's the difference between a termination and an abortion?
Unlike a termination, an abortion is defined as a voluntary interruption of pregnancy for medical reasons (a risk to the woman's health or fetal abnormalities). It can be carried out right up to the end of gestation. An abortion can be carried out up to the 14th week of amenorrhea, and is the result of the personal wishes of the woman, who remains free to dispose of her body.
Is medical abortion painful?
Physically, a medical abortion is similar to a conventional childbirth, and can therefore be painful. Pregnant women may, however, request a general anaesthetic (epidural), after consultation during a pre-anaesthetic consultation. Expulsion is generally carried out under epidural to minimize pain.
