De Costa, Caroline (2011) Induced abortion. In: Russell, Darren, Bradford, David, and Fairley, Christopher, (eds.) Sexual Health Medicine. IP Communications, Melbourne, VIC, Australia, pp. 314-320.

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Abstract

[Extract] Increasingly it is being recognised that sexual health physicians have an important role to play in the provision of induced abortion, both medical and surgical in Australia. Women with an abortion-related request may present to a sexual health clinic in a variety of ways, as the following real-life stories show.

Ashleigh Ashleigh, aged 24, first attended her local sexual health clinic on the Tuesday following a long weekend. Ashleigh had stopped taking the combined oral contraceptive pill two months earlier, after breaking up with her long-term partner. A last-minute invitation to a party over the weekend led to her meeting Tim, which resulted in several episodes of unprotected sex. On Tuesday Ashleigh was worried about the possibility of an STl, although she didn't think she could be pregnant because 'my periods haven't come back yet'. A full STI screen was negative-but a urine pregnancy test ten days later at the clinic was positive.

Marlee Marlee, aged 16, had her first contact with a sexual health clinic when she was 14, when her boyfriend told her he'd been treated for chlamydia. Marlee had not been happy about the chlamydia but she had liked the sympathetic and non-judgemental manners of the clinic staff and their explanations of her treatment. So the clinic was where she went when she did a home pregnancy test and found it positive. Marlee had no doubt that she wanted an abortion, and she needed information about how she could have the procedure.

Donna Donna, aged 39, was referred to the sexual health clinic of a large regional town by her GP, who was aware that the clinic offered early medical abortion at no cost to the client. Donna was the single mother of three teenage children, the pregnancy was the result of a brief casual relationship, and she coutd not afford the costs involved in procuring a surgical abortion in a city some 400 km away. In the course of her pre-abortion workup Donna was found to have a gonococcal infection, which was appropriately treated.

Since both STIs and unplanned pregnancy may be the consequences of unprotected sex, it is hardly surprising that the two conditions may present together. As shown in the case histories above, presentation may follow one or more episodes of unprotected sex, consensual or nonconsensual, and initially this presentation may be because of the woman's concern that she has contracted an STI. Subsequently pregnancy may be diagnosed. (If pregnancy has occurred a urinary B-HCG will usually be positive from 14 days following ovulation, and a blood test will usually be positive from 6-7 days following ovulation.) The pregnancy, while probably unplanned, may not be unwanted. The woman's feelings about the diagnosis of pregnancy and her social and economic circumstances, as well as any relevant medical conditions, should be discussed in an unhurried, nonjudgemental fashion, and she should be offered information about all three options for unplanned pregnancy - abortion, adoption and parenting - and have time to consider these options. This advice may be given within the sexual health clinic consultation or by referral to a pregnancy advisory service (either for face-to-face or telephone discussions), or by an abortion provider, depending on the wishes of the woman. If the woman has a supportive partner he should be included in these discussions. In some cases the diagnosis of pregnancy may be made in the course of a more complex presentation, e.g. following sexual assault, in which case the assistance of a trained counsellor may be appropriate.

Item ID:	17238
Item Type:	Book Chapter (Teaching Material)
ISBN:	978-0-9808649-1-5
Date Deposited:	21 Jun 2011 05:59
FoR Codes:	11 MEDICAL AND HEALTH SCIENCES > 1114 Paediatrics and Reproductive Medicine > 111404 Reproduction @ 100%
SEO Codes:	92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920114 Reproductive System and Disorders @ 100%
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