Early ultrasound examination is more accurate than last normal menstrual period at determining gestational age, and also of value in identifying ectopic pregnancy, molar pregnancy or twins.
The legal criteria for TOP follow below. The clinical management for pregnancies up to 14 weeks is the same (outpatient procedures). From 14 weeks onwards, TOP should be done in a medical facility. Note that the gestational ages used for clinical management differs from the legal cut-offs, e.g. a patient at 12 weeks and 1 day will meet the legal requirements as described in the act for TOP after 12 weeks, but the clinical management is the same as for a pregnancy from day one up to 14 weeks (see below).
Summary of Choice of Termination of Pregnancy Act
Women eligibility
Up to 12 weeks and 0 days: On request.
From the thirteenth week (12 weeks and 1 day) up to the twentieth week (19 weeks and 6 days): If doctor is satisfied that pregnancy was from rape or incest, or there is risk of fetal abnormality or risk to mother’s physical or mental health or social or economic circumstances.
More than 20 weeks (≥ 20 weeks 1 day): Doctor and second doctor or registered midwives are satisfied that there is danger to the mother’s life, a lethal or severe fetal malformation or fetal death.
Venue
An accredited facility with staff trained in performing TOP, designated by the Member of Executive Council at provincial level.
Practitioner
Up to 12 weeks and 0 days: Doctor, midwife or registered nurse with appropriate training.
From the thirteenth week (12 weeks and 1 day) up to the twentieth week (19 weeks and 6 days): Doctor responsible for decision and prescription of medication; registered nurse/midwife may administer medication according to prescription.
- Pre-and post-termination counselling and contraceptive counselling is essential.
- Consent of spouse/partner is not necessary.
- Consent for TOP and related procedures e.g. laparotomy may be given by minors. Minors are encouraged to consult parents or others, but consent is not mandatory.