Routine ultarsound for pregnancy termination requests increases women' choice and reduces inappropriate treatments

Authors


Sir,

In the January issue of the BJOG, Catherine McGalliard and Marco Gaudoin from Scotland demonstrate the potential benefits of scanning all women who request pregnancy termination.1 They point to the widespread underuse of ultrasound technology for the benefit of a substantial part of our patients. Sensitive routine scanning done as part of the admission preparation will mean that non-viable pregnancies are discovered sparing the women a ‘termination’ and knowledge of gestational length matters, particularly when there is a choice of conventional suction evacuation and medical termination. Claiming novelty is, however, liable to fault and it is interesting to notice that their data are very similar to those published in the Scottish Medical Journal by myself and Dr. Yashid Jarallah (currently in Palestine) almost 20 years ago.2

In that short paper, we reported on 753 women who had attended the Perth Royal Infirmary seeking termination of pregnancy. It was routine at the time to scan all women referred with such a request before they were seen by the doctor. We found that in 6.9% of cases, the women did not have a viable pregnancy and 2.5% in addition were not pregnant. The women were able to give what was called ‘certain dates’ in 73% of cases and of these ultrasound confirmed gestational length (±one week) in 62%, but 22% were further on and 16% less far on. In 27%, scan information alone had to be relied upon. I am glad to have agreed with the findings of our colleagues for the last 20 years. Law and Wilkins3 had even earlier reported similar results and suggested that scanning contributed much to management for these women. Our study and this new one do so as well. We suggested that a correct diagnosis of a non-viable pregnancy would mean that a number of women would be spared the social and psychological stigma of having a termination of pregnancy, as well as pointing to the importance of correct dating of pregnancies even for termination. A randomised study that has looked at the effects on women of finding non-viable pregnancies when termination is sought may not exist. The short and long time sequela of abortion have, however, been described repeatedly, including in a study we quoted and was published in this Journal in 1980.4 The poor reliability of menstrual history is also well known.5

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