Vacuum aspiration before 7 weeks
Mike Vidot, Clinica El Sur. Sevilla. Spain
Until now pharmacological termination of pregnancy has been considered the method of
choice in pregnancies below 7 weeks. In our experience surgical vacuum aspiration is also
a safe and alternative method which can be used before 7 weeks, as long as a proper
preoperative surgical assessment is performed. This technique has numerous advantages
compared to the pharmacological method. It is as safe as the pharmacological method, but
with more advantages for the patient. The procedure is immediate, less cost effective for
both the clinic and the patient, reduces the psychological effects that an unwanted
pregnancy can cause, gives the patient the opportunity for immediate contraception after
termination of pregnancy and can be implemented in countries whereby anti-
prostaglandins are not available.
Why abortion is performed in Spain until 26 weeks
Mike Vidot, MD, Clinica El Sur, Sevilla, Spain
In Spain abortions can be performed based on a law of indications (Decree 9/1985; article
417), which has not been modified in posterior reforms of the Penal Code of Conduct.
This law states that abortion will not be pursued in Spain if it is practiced by a doctor or
under his or her supervision when certain circumstances are given:
- A pregnancy which results in a serious risk for the mothers’ physical and psychological
health, diagnosed by a specialized physician, without gestational age limits.
- Pregnancies resulting from rape can be performed up to 12 weeks.
- Pregnancies up to 22 weeks when the foetus presents a high probability of having
physical and psychological alterations certified by 2 different specialized physicians.
These physicians under no circumstances should be the ones who perform the
Hence, that’s why we think that in Spain we can consider that induced abortion is not
voluntary, but a necessity derived from a situation.
Also the WHO defines health as: a state of physical, psychological and social wellbeing,
not the mere absence of diseases.
Based on these 2 aspects (without gestational age limits where the mothers health is
concerned and the definition of health by the WHO), in Spain, the private specialised
clinics in abortion, interpret that if there is a criteria which estimates that a pregnancy is of
high risk for the mothers health, this can be performed without a gestational age limit,
understanding that an unwanted pregnancy alters the psychological and social welfare and
that her health is at risk.
On the other hand WHO in its Technical Resolution 461 defines abortion as ¨the
interruption of pregnancy before its viability¨.
The clinics of ACAI (Association of Accredited Clinics for Voluntary Interruption of
Pregnancy) interpret that according to WHO, as soon as foetal viability is given, it is not an
abortion and that the law could not be applied. Hence, based on the fact that foetal viability
is considered from 25 to 26 weeks onwards, pregnancies with healthy foetuses up to 26
weeks can be interrupted if there is a psychiatric report certifying that there is a risk for the
mothers mental health. Also, estimating that abortion is the best option in such cases
pregnancies are interrupted beyond 26 weeks when a foetal malformation is not
compatible with extra uterine survival or human dignity. In such cases a certificate of none
viability signed by 2 different obstetricians is required. This legal interpretation of the law
has not been questioned judicially until now.
This has converted Spain in a destination for abortion, mostly from the European
countries with Voluntary Interruption of Pregnancy laws which complicate the access of
women who are more than 12 weeks pregnant or those countries which have restrictive
laws regarding abortion above 22 weeks.
The Private Specialized Abortion Clinics have assumed also abortions which are not being
performed in Spanish public hospitals. They only accept those with foetal pathology until
22 weeks, pregnancies derived from rape or which puts in danger the mothers’ health.