Procedures for performing a surgical termination of pregnancy 1994

THE MINISTRY OF HEALTH OF THE REPUBLIC OF LITHUANIA,

ON PROCEDURES FOR PERFORMING A SURGICAL TERMINATION OF PREGNANCY

(Vilnius, order no. 50 of 28 january 1994)

ON PROCEDURES FOR PERFORMING A SURGICAL TERMINATION OF PREGNANCY

Seeking to reduce the number of surgical terminations of pregnancy and the complications associated with them:

1. I do hereby establish procedures for the performance of surgical terminations of pregnancy (Annex No. 1).

2. I do hereby approve a list of diseases and conditions that are harmful to the health and life of the mother and the fetus (Annex No. 2).

3. This Order shall come into effect upon its publication in the "Valstybės žinios" Official Gazette.

4. I do hereby establish that the procedures for surgical terminations of pregnancy approved by order No. 234 of 03-16-1982 of the Ministry of Health of the USSR shall no longer be in effect in the Republic of Lithuania.

MINISTER OF HEALTH 
JURGIS BRĖDIKIS

Annex No. 1 t
Order No. 50 of January 28, 1994
of the Ministry of Health

PROCEDURES FOR SURGICAL TERMINATION OF PREGNANCY
   

1. Termination of pregnancy upon a woman's request.

1.1. Pregnancy may be terminated upon a woman's request up to 12 weeks, provided there are no contraindications to this surgery. Termination of a pregnancy beyond 12 weeks is permitted in cases when the pregnancy threatens the life and health of the woman (Item 2).

1.2. Contraindications to termination of pregnancy:
acute and subacute inflammation of the genitalia;
acute and subacute inflammation in other locations;
acute infectious diseases.
Surgical termination of a pregnancy is permitted only after the aforementioned diseases have been treated.

1.3. In all cases, termination of pregnancy may only be performed at an inpatient gynecology department.

1.4. Women must consult an obstetrician-gynecologist providing outpatient therapy for a referral to an inpatient gynecology department.

1.5. The potential harm to a woman's health caused by the termination of pregnancy, as well as the physical and moral damage to both spouses must be explained to the woman (and preferably her spouse) before issuing a referral for termination of pregnancy. This information must be provided by the obstetrician-gynecologist issuing the referral and, in the case of a first pregnancy, by the physician together with the Head of a Women's Consultation Centre. Participation in the conversation by a psychologist is desirable.

1.6. The written consent of one of the parents, foster parents, guardians, caregivers, or persons actually raising the child is mandatory in cases of a termination of pregnancy to be performed on a minor girl under the age of 16, and in the case of girls from the age of 16 to 18, the aforementioned consent is desirable. The person giving consent must present him/herself in person or his/her written consent must be certified by a notary.

1.7. A Women's Consultation Centre obstetrician-gynecologist shall establish the length of pregnancy and verify that there are no contraindications to this surgery before issuing a referral for termination of pregnancy.
The following tests shall be performed for pregnant women:
general blood test;
WaR blood test;
cervical smear;
blood type and Rh test;
a blood test for AIDS shall be performed only in the presence of clinical and epidemiological symptoms, and with the patient's consent or at her request.
Other clinical, laboratory or special tests shall be conducted in the presence of indications.
Data obtained by means of these tests must be included on the out-patient card.

1.8. The following information must be included in the referral for termination of pregnancy (Form No. 028/y): duration of pregnancy, test results and, in the presence of medical indications, the condition due to which the pregnancy may be terminated.

1.9. Women must express their decision to terminate the pregnancy in writing at a gynecology inpatient department prior to the surgical termination of a pregnancy.

1.10. Surgical terminations of pregnancy shall be performed by obstetricians-gynecologists of gynecology inpatient departments, while micro abortions shall be performed by obstetricians-gynecologists at Women's Consultation Centers with equipped surgery rooms.

1.11. A medical history (Form No. 003-1/a) must be completed at the gynecology inpatient department, into which the referral for termination of pregnancy and the woman's written consent to termination of pregnancy must be included.
Surgical terminations of pregnancy shall be registered in the surgery records.

1.12. Surgical terminations of pregnancy must only be performed under anesthesia.

1.13. Anti-rhesus D immunoglobulin shall be administered after the surgical termination of a first pregnancy.

1.14. The time of a woman's discharge from a gynecology inpatient department shall be determined by the obstetrician-gynecologist.

1.15. An obstetrician-gynecologist may issue a disability certificate to working women for a period not exceeding 2 calendar days following the surgical termination of pregnancy. In the event of complications, the validity period of the disability certificate shall be extended in accordance with procedures established by regulations (see Regulations for the Issuance of Disability Certificates of July 29, 1991).

1.16. In case of a spontaneous abortion or termination of pregnancy for medical reasons, a disability certificate shall be issued to working women starting from the first day of incapacity for work (see Regulations for the Issuance of Disability Certificates of July 29, 1991).

1.17. Following a surgical termination of pregnancy, an inpatient obstetrician-gynecologist must send an extract Form No. 027/a to the referring Women's Consultation Centre.

1.18. Obstetrician-gynecologists who, based on an examination of a patient, suspect that a criminal abortion may have been performed must immediately inform the Head of the institution and the latter must inform the public prosecutor's office.

2. Termination of a contraindicated pregnancy.

2.1. If a pregnancy poses a threat to the life and health of a mother it shall be terminated irrespective of the duration of pregnancy (List of diseases and conditions that are harmful to the health and life of the mother and the fetus in Annex 2).
A pregnancy may be terminated only in the event of an actual threat to the mother's health and life. Termination of pregnancy up to the twelfth week of pregnancy is recommended.

2.2. In the event of a disease or condition posing a threat to the health or life of a mother or fetus, women of childbearing age must be registered for follow-up care. Women seeking to give birth must be thoroughly examined before becoming pregnant. A medical board shall decide on issues regarding planning and continuation of pregnancy and the selection of long-term contraceptive methods in the event of a contraindicated pregnancy. It shall also evaluate the indications for the termination of a pregnancy.

2.3. Medical commissions shall operate at the Vilnius University Women's Clinic, the Kaunas Medical Academy Clinic for Obstetrics and Gynecology, the Klaipėda City Hospital, and the Šiauliai and Panevėžys Republican hospitals.
An obstetrician-gynecologist must be designated as the chairperson of the medical commission. In addition, the commission must consist of a therapist and a neurologist, and a physician specializing in the profile of the disease must be invited to the board. The appointment of a chairperson of the commission must be coordinated with the heads of the perinatology centers.
Women must be familiarized with the decision adopted by the medical commission and affirm this under signature. Conclusions of a medical commission concerning termination of pregnancy for medical reasons must be certified by the signatures of the members of the commission, its chairperson, and the seal of the medical institution. The conclusion shall be recorded in Document No. 27. In cases of mental or venereal diseases, this document shall be sent directly to an obstetrics-gynecology inpatient department.

2.4. Upon diagnosis of fetal abnormalities incompatible with life, the pregnancy may be terminated only after the possible effects on the mother's health of a premature termination of pregnancy are explained to the woman (and preferably to her spouse as well).

2.5. The termination of a pregnancy exceeding 12 weeks' duration for medical reasons shall be conducted at the Vilnius and Kaunas perinatology centers.

2.6. Women shall be transported for terminations of pregnancy for medical reasons by means of vehicles belonging to republican hospitals.

3. The consent of a woman (and preferably her spouse as well) is mandatory in all cases for a termination of pregnancy.

4. The surgical termination of a contraindicated pregnancy shall be performed free of charge; in other instances it shall be paid for subject to rates established by the Ministry of Health.

Note: Obstetricians-gynecologists who are engaged in private practice must also comply with the procedures for the surgical termination of pregnancies.

HEAD OF THE MATERNAL AND CHILD
HEALTH CARE DEPARTMENT 

. VAINAUSKIENĖ