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112 Maternity and Obstetrics 2020 | NMH Annual Rep t T he National Maternity Hospital is one of ten maternity units within the state providing a termination of pregnancy service. The hospital provides care under each of the four legal provisions for termination of pregnancy care: <12 weeks estimated gestational age, risk to life or health of mother, risk to life or health of mother in an emergency, and the presence of a condition likely to lead to the death of the fetus. Options for surgical and medical termination of pregnancy care is given to all women <12 weeks estimated gestational age and, gestation dependent, to those with maternal or fetal issues. The majority of people attending for care are less than 12 week's gestation (71%), followed by fetal indication (22%), maternal (5%) and emergency (2%). Over half (60%) underwent a surgical termination of pregnancy and the remainder (40%) were medical. For both, extensive multidisciplinary input is required to provide safe, respectful, compassionate care to the women and their families. Teams involved include Obstetrics, Maternal Fetal Medicine, Neonatology, Midwifery, Nursing, Anaesthesiology, Bereavement, Chaplaincy and Perinatal Mental Health (Psychology and Psychiatry). Clinicians working in the hospital also lead on a project with the HSE to provide an information leaflet on 'Compassionate induction of labour' for those within the Fetal and Maternal groups as this was identified as a gap within the service. Clinical staff also actively participated in a research project with Trinity College Dublin, funded by the HSE, on women's experience within the termination of pregnancy service. First Trimester Service In 2020, most women had only one visit to clinic. Of these, four women chose to continue in their pregnancy following attendance in the clinic, often requiring many hours of discussion with clinic staff members. Two women were booked for termination of pregnancy but did not attend the hospital for the procedure. Women under the age of legal consent are also seen by the medical social work team and mandatory referrals have been made to Tusla. Some women have also required the input of the Sexual Assault Unit, the Gardai (if allegations of assault) or the Genito-urinary medicine teams (if positive for sexually transmitted infections). Termination of Pregnancy Service First trimester termination of pregnancy are equally divided between medical and surgical termination of pregnancy based on woman's preference and medical need. For medical termination of pregnancy, women are admitted directly to a single room on the Gynaecology Ward. Over half will complete the termination of pregnancy within six hours and the remainder require an overnight stay to complete the process. For surgical termination of pregnancy, women are also admitted directly to a single room in the Gynaecology Ward. Most are discharged post procedure within six hours of admission. Some patients attended for Anti-D following a medical termination of pregnancy in the community between seven and nine weeks, requiring midwifery, laboratory science and medical input. There were further attendances following 'unsuccessful' community termination of pregnancy – that is, that they had a persistent positive pregnancy test after the community termination of pregnancy. Some of these women had a positive pregnancy test due to retained products of conception and required an evacuation of retained products of conception. A small minority had an ongoing pregnancy and attended for consideration of repeat termination of pregnancy (surgical). Termination of Pregnancy for Maternal Medical Conditions Some women underwent termination of pregnancy due to a maternal medical condition that met the criteria for the Act. Planning for termination of pregnancy due to maternal medical conditions involves the input of multiple specialities to provide safe and respectful care. We continue to be grateful to our General Medical and Speciality colleagues in St Vincent's University Hospital for their input into the care of this complex group. Termination of Pregnancy for Fetal Abnormalities 2020 was the second year since the Health (Regulation of Termination of Pregnancy) Act 2018 was passed into law and permitted access to abortion in Ireland. There were 28 patients seen at the National Maternity Hospital who met the criteria for FFA/LLC under Section 11 of the Act and underwent termination of pregnancy. The majority (25) of these cases were looked after at the NMH and the remaining 3 returned to their referring hospital for delivery.