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After a woman's egg is fertilized by a man's sperm, the fertilized egg moves along the fallopian tubes and becomes embedded in the lining of the uterus. At this point the pregnancy formally begins.
For couples who are prepared for parenthood, the pregnancy is a much welcomed event. But for those who are not prepared for it, an unplanned pregnancy can bring much anxiety and distress. |
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Causes and Sign of an Unplanned Pregnancy
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Factors which may result in an unplanned pregnancy include:
| ¡» | No contraception used; |
| ¡» | Contraception used wrongly, e.g. forgetting to take oral contraceptive pills, or wearing condoms incorrectly; |
| ¡» | Contraceptive failure, e.g. expulsion of intra-uterine device(IUD), using contraceptive products beyond their expiry date. |
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| If a woman discovers that her menstrual period is overdue, and has symptoms of breast swelling, nausea, vomiting or frequent micturition, she may be experiencing signs of early pregnancy. Pregnancy can be confirmed one to two weeks after her missed menstrual period by a urinary pregnancy test (preferably on the first morning specimen of urine). |
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The Pregnant Woman's Options
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The pregnant woman can choose to continue with the pregnancy or to terminate it by having an abortion. This is different from a natural abortion (miscarriage) which was caused by problems during pregnancy. Before deciding, the woman should carefully consider various factors relating to her physical, social and emotional well-being. These include her state of health at the time of pregnancy, practical social circumstances such as her financial condition, the number of children she may already have, the pregnancy's effect on her vocational or academic pursuits, her relationship with her partner and their views on life and childbearing.
If the woman decides to continue with the pregnancy, she should attend regular ante-natal check-ups to safeguard the health of herself and her baby. Single teenage mothers who decide to have the baby may apply to voluntary agencies such as Caritas, Mother's Choice or the Birthright Society for residence in hostels for unwed teenage mothers where they can stay until they give birth. After the baby is born, they can choose either to keep the baby themselves or to arrange with the Social Welfare Department for adoption.
If the woman decides to terminate her pregnancy, she should learn more about the procedure and safety of the operation. Termination of pregnancy operations should be provided in full compliance with the Offences Against the Person Ordinance (Chapter 2.2). In Hong Kong, illegal abortion on oneself or on others is liable to prosecution with possibility of penalty and imprisonment.
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Applying for legal Termination of Pregnancy
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According to Section 47 of the Offences Against the Person Ordinance, termination of pregnancy requires two registered medical practitioners to concur that:
| ¡» | continuing the pregnancy would involve risk to the life of the pregnant woman or of injury to the physical or mental health of the pregnant woman greater than if the pregnancy were terminated; or |
| ¡» | there is a substantial risk that if the child were born, it would suffer from such physical or mental abnormality as to be seriously handicapped; or |
| ¡» | the woman is with child before attaining the age of 16; or |
| ¡» | the woman is the victim of incest, rape, drug rape, intercourse by threats, or intercourse by false pretences, and has made a report to the police within 3 months after the date of such offences. |
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| Legal termination of pregnancy must not be performed after the 24th week of pregnancy, unless the abortion is absolutely necessary for saving the pregnant woman's life. It must be performed in government specified hospitals or the operating theatres of the Family Planning Association of Hong Kong, and by registered doctors. |
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Methods for Termination of Pregnancy
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The operation can be carried out under local or general anaesthesia.
For early pregnancies which are less than 12 weeks in duration, the most commonly used method is suction evacuation. A plastic or metal suction tube is inserted through the cervix into the uterus and vacuum suction is applied to remove the gestational products.
Pregnancies which have progressed beyond 12 weeks can be terminated with drugs such as prostaglandins, administered through intravenous injections or by vaginal suppositories. They stimulate the uterus to contract and expel the foetus. |
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Safety of Termination of Pregnancy
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The safety of termination of pregnancy is closely related to the duration of the pregnancy, the method used, the skill of the doctor and the standard of the facilities.
Operations performed in early pregnancy are generally safer because the method used is simpler. The chance of dying due to termination of an early pregnancy is only 1 in 100,000.
Any illegal termination of pregnancy can be risky for there are no standards governing the doctor's competence, conditions of hygiene, or type of instruments used and there may be a lack of resuscitative equipment. |
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Post-operative Side Effects and Complications
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Generally speaking, a woman who has had her pregnancy terminated at an early stage of pregnancy can return to work the next day. A woman who has had her pregnancy terminated at a later stage may need to remain in hospital for observation for a longer period . After the abortion, women may have bleeding and abdominal pain. If the bleeding or pain persists or intensifies, the woman must seek medical advice. The chance of dying due to termination of an early pregnancy is only 1 in 100,000.
Although termination of an early pregnancy is not a major operation, it can still give rise to the following complications, including:
| ¡» | Heavy bleeding: The more advanced the pregnancy, the more blood is lost during termination. In serious cases, further surgery or even removal of the uterus may be needed to stop the bleeding. |
| ¡» | Pelvic infection: If the infection spreads to the fallopian tubes, this can result in infertility in future. |
| ¡» | Perforation of the uterus, possibly leading to injury to the intestines or the bladder. |
| ¡» | Injury to the cervix: This may predispose to miscarriage or pre-term birth in future pregnancies. |
| ¡» | Termination of more advanced pregnancy may involve general anaesthesia: Drug allergies and hypoxia can occur but are relatively rare. |
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How to prevent Unplanned Pregnancy
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| To prevent unplanned pregnancies from occurring, every woman should have a correct understanding of contraception and adopt effective measures for birth control. Unwed teenage girls should carefully consider the consequences of premarital sex. If they choose to engage in sexual activity, they should use effective contraceptive methods. |
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Choosing an effective Contraceptive Methods
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There are many different methods of contraception: men can use the male condom, women can use the oral contraceptive pill, contraceptive injection, intra-uterine device, diaphragm, female condom, spermicides or periodic abstinence. Couples who decide not to have any more children may consider male vasectomy or female sterilization for permanent contraception.
Different contraceptive methods have different mechanisms of action and different effectiveness, but for each method there is still the possibility of unplanned pregnancy. In order to minimize this chance, it is advisable to consult a doctor and to have a physical check-up before selecting an effective form of contraception that is best suited to one's needs ,and then to use it correctly in accordance with instructions.
Even if no contraception is used during sexual intercourse, or if contraception failed, emergency contraception can be used to prevent unplanned pregnancy. This may be achieved by taking emergency contraceptive pills within 72 hours of sexual intercourse, or by inserting an intra-uterine device within five days of sexual intercourse. Both methods, however, should only be used after medical consultation and physical check-up. |
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Regular Physical Checkups
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| The effectiveness of each contraceptive method varies with the physical state of the user, and may be affected by illness, childbirth and changes in lifestyle habits. Sexually active women, whether married or unmarried, should therefore have regular check-ups to see if they need to switch to another method. |
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Counseling on Termination of Pregnancy
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| The Birth Control Clinics of the Family Planning Association provide counselling service for termination of pregnancy. Unmarried pregnant women below the age of 26 can approach the Youth Health Care Centres for assistance. Referral to Hospital Authority or private hospitals can also be arranged upon request. Termination of pregnancy operations must be performed in gazetted hospitals or in the operating theatres of the Family Planning Association of Hong Kong.
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