Alisha Shahid
Age: 16 years old female
Examiner
Marking Scheme
Data Gathering and Diagnosis
- Clarify the reason why the patient is seeking an abortion
- Ask about her last menstrual period (LMP) to estimate gestational age
- Ask how she confirmed the pregnancy (e.g., urine test, private ultrasound scan)
- Explore whether she has spoken to anyone about the pregnancy (e.g., family, friends, partner)
- Due to her age, ask about her partner — confirm age, nature of relationship, and if he is in the same class
- Check whether she feels safe in her relationship and ask sensitively if she was ever coerced or forced into sex.
- Screen for symptoms suggestive of STIs or ectopic pregnancy (vaginal discharge, bleeding, pelvic pain, shoulder tip pain, intermenstrual bleeding).
- Ask about contraceptive use: If using contraception, ask what type and explore reasons for failure (e.g., missed pills, expired condoms)
- Ask if she has ever been pregnant before, because at 16, a previous pregnancy may raise safeguarding concerns, prompt assessment of support systems, and inform the level of emotional and medical guidance she may need.
- Explore lifestyle: smoking, alcohol use, recreational drugs
- Ask about her home situation and who lives with her
- Ask what she knows about abortion and whether she has done any reading or research about it.
- Ask if she has thought about any other options (e.g., continuing the pregnancy or adoption), and whether she would be open to discussing them.
Example of explanation to patient
Thank you, Alisha, for explaining everything so clearly. I understand that you are considering an abortion, and I want to make sure you have all the information you need to make the best decision for yourself. I’m here to support you through this process.
There are two main types of abortion: medical abortion and surgical abortion. Let me explain both.
Medical abortion: This option is usually suitable for pregnancies up to 10 weeks, and as you’re 7 weeks pregnant, it’s a good choice for you. With a medical abortion, you take two types of tablets; one is taken with water via your mouth and the other is either inserted through your front passage (Vagina) or between the cheek and gum. The experience is similar to having a heavy period, and you may have cramping and bleeding, which can last a few days. Many women find that taking ibuprofen or paracetamol helps with the pain. Although this method is generally effective, there is a small risk that the abortion may not be complete. If this happens, you may need a surgical abortion to remove any remaining tissue.
Surgical abortion is a procedure where the pregnancy is removed from the womb using gentle suction or surgical instruments. It is commonly offered after 10 weeks of pregnancy, although it may be done earlier as well. The procedure typically takes just a few minutes, and you’ll be given local anaesthetic or sedation to ensure you’re as comfortable as possible. Like any medical procedure, it carries small risks such as infection, injury to the cervix or womb, or incomplete abortion, which might require further treatment, but overall, it is considered very safe.
Alisha. I also want to let you know that there are alternatives to abortion that some people consider. One option is continuing the pregnancy and carrying it until delivery, with the intention of giving the baby up for adoption afterward. If this is something, you would consider, then we can talk more on that.
Once we’ve helped you with this situation, I’d like to suggest we book another appointment in the future to talk about contraception, just so we can help prevent this from happening again if that’s what you’d like.
There are quite a few options, including tablets you take every day, but also other types that don’t need you to remember anything daily — like the implant which is inserted just under the skin of your upper arm or the coil, that’s placed gently inside the womb through your front passage. They’re all safe and effective, and we can talk through what might suit your lifestyle best.
There’s no pressure to decide now, I’ll send you a leaflet so you can read about the different choices in your own time. When you’re ready, we can chat more about what might suit you best. I’m here to support you.
We normally recommend STI screening for people who are sexually active, just to ensure your overall health and avoid any potential complications. Some STIs can be unnoticed and could affect your health, so it’s a good idea to get checked.
Alisha, I completely respect your decision and your right to keep this private. But I’d like to encourage you to think about confiding in someone you trust, maybe your older sister, an aunt, or another adult you feel safe with. The reason I say this is not to pressure you, but because after a medical abortion, there’s usually some bleeding and cramps, and although things often go smoothly, very occasionally the bleeding can become heavier than expected.
If that were to happen and you were alone or unable to get help quickly, having someone nearby who knows what’s going on could make all the difference in helping you stay safe. It’s just about making sure you’re supported.
Management
- Explain that there are two main types of abortion: medical (using tablets) and surgical (a minor procedure done in a clinic).
- Since she is around 7 weeks pregnant, medical abortion is a safe and effective option. It involves taking two types of medication a couple of days apart.
- Reassure her that it’s normal to experience bleeding and cramping, usually within the first 3–7 days, as the body passes the pregnancy. Pain relief such as ibuprofen or paracetamol can help manage this.
- Explain that in some cases, the abortion may not be fully complete and a small number of people may need a surgical procedure afterwards. However, this is not common and she will be well supported either way.
- Gently let her know that continuing the pregnancy and placing the baby for adoption is also an option, if she would like to think about that.
- Encourage her to consider involving a trusted adult — such as a parent, older sibling, or aunt — for support. If she prefers not to involve her parents, check if there is someone else she trusts and feels safe confiding in.
- Arrange a referral to either BPAS (British Pregnancy Advisory Service), MSI Reproductive Choices UK or National Unplanned Pregnancy Advisory Service (NUPAS), where she’ll get more information, support, and access to abortion services.
- Recommend a visit to the sexual health clinic for a routine STI screen, which is often offered as part of abortion care.
- Offer to discuss contraceptive options to help prevent future unplanned pregnancies — this can include daily pills or longer-acting options like implants or the coil.
- Provide leaflets or links to trusted websites so she can read more in her own time.
- Reassure her that you’re here to support her with no judgement, and that she’s not alone in this.
- Advise her that if she goes ahead with a medical abortion, she should seek urgent medical help if she experiences very heavy bleeding (soaking two or more maxi-size sanitary pads per hour for over two hours), severe abdominal pain not eased by painkillers, high fever or chills, or symptoms like fainting, dizziness, or confusion.
- Emphasise the importance of doing a follow-up pregnancy test in 3 weeks (this will usually be provided by the clinic) to confirm that the abortion is complete.
Learning point from this station:
This station highlights the importance of providing safe, confidential, and compassionate care to young people seeking advice on abortion. Health promotion plays a key role — offering STI screening and signposting to the local sexual health clinic is essential to ensure holistic care and reduce the risk of future complications.
It is important to explore contraceptive use and offer education on safer and more suitable options moving forward. In cases where the pregnancy occurred due to missed pills (COCP or POP), it provides a crucial opportunity to discuss Long-Acting Reversible Contraceptives (LARC) such as implants or coils, especially if daily adherence to pills is a challenge.
Abortion is a sensitive subject, and clinicians must remain non-judgmental and show sensitivity throughout the consultation. Signposting before asking personal or intimate questions helps create a safe environment for open discussion.
Legally and ethically, Fraser guidelines apply when giving contraceptive and sexual health advice to patients under 16. The Fraser guidelines require that:
- The young person cannot be persuaded to involve a parent or carer.
- The young person understands the advice and implications.
- Their physical or mental health is likely to suffer without the advice or treatment.
- It is in their best interests to receive treatment or advice without parental consent.
- They are likely to continue having sex with or without contraception.
Additionally, Gillick competency must be assessed to determine whether the young person has the maturity and understanding to make decisions independently. This includes evaluating their understanding of the issue, risks, consequences, and alternatives, and ensuring they can clearly explain their reasoning.
Ultimately, the role of the healthcare professional is to ensure the young person is informed, supported, and protected while encouraging open communication with a trusted adult where possible — always balancing confidentiality with safeguarding responsibilities.