Termination of early pregnancy in Ireland: Review of the first four years of inpatient service at a tertiary maternity unit

Background: In 2019, a termination of pregnancy (TOP) service was established in Ireland following a landmark change to the constitution. Under Section 12 of the Health Act, TOP is permitted without restriction until 12 + 0 weeks’ gestation. Methods: Retrospective review of inpatient medical TOP under Section 12 between 1 January 2019 to 31 December 2022 in a single tertiary maternity hospital in Ireland. Anonymised data from eligible cases was obtained from electronic healthcare records. Results: The final cohort included 149 individuals. Gestational age (>9 + 0 weeks’) was the primary indication for hospital TOP (81.2%) with over 44% of the cohort at >11 + 0 weeks’ gestation. Misoprostol was administered within the recommended 24–48 h from mifepristone in 75.2% of cases. After one course of the medication regime, 9.4% of individuals required additional doses of misoprostol to complete the termination. Haemorrhage with blood loss >500 ml occurred in 4.2% of cases, with no other major/significant complications reported. Conclusion: This is the first reported review of the efficacy and complications of the newly established Irish TOP service. Findings highlight the importance of timely access to care given the strict legal gestational cut-off. Variations in practice, specifically in timing of medication administration, were also shown.