Position statement following Chief Coroner’s Guidance no. 45, “Stillbirth and Live Birth Following Termination of Pregnancy” Advice for clinicians following abortion care at later gestation

In February 2023 the Chief Coroner for England and Wales published Guidance No. 45 entitled “Stillbirth and Live Birth Following Termination of Pregnancy” with a view to achieving consistency in coronial practice.
The guidance has prompted a need for clarity for healthcare professionals caring for women needing an abortion. This statement is intended to act as a resource for healthcare professionals to inform standards of clinical practice, mitigate potential variations in care, and to ensure that no unnecessary barriers are introduced for those accessing abortion care.
 Livebirth following medical abortion is uncommon but can occur, particularly at later gestations. Determining whether a livebirth has occurred at earlier gestations can be challenging, thus healthcare professionals need to be aware of guidance for determining signs of life, and what to do when there is uncertainty.
 Healthcare professionals should draw on the principles of the MBRRACE-UK guidance for determining signs of life after birth and should include one or more of the following: easily visible heartbeat seen through the chest wall; visible pulsation of the cord after it has been clamped; breathing, crying or sustained gasps; definite movement of the arms and legs. They should be aware that fleeting reflex activity including transient gasps, brief visible pulsation of the chest wall or brief twitches or involuntary muscle movement can be observed in neonates that have died shortly before birth and therefore should not be considered as representing signs of life when observed in the first minute after birth.
 Healthcare professionals should support women to make informed choices through an individualised, informed discussion, related to the chance of signs of life after medical abortion, and where appropriate, a discussion of feticide and plan of care for the neonate if it is born with signs of life. These discussions should be clearly documented.
 Feticide, as a procedure to prevent the fetus from being born alive, should be discussed with patients when there is a significant chance of a livebirth occurring following abortion and is recommended by the RCOG where medical abortion is performed after 21 weeks and 6 days.
 Health care professionals need to be aware of the relevant legislation related to abortion and the responsibilities of medical practitioners related to establishing whether there has been a livebirth and whether referral to the coroner/Procurator Fiscal is required. There is variation in these responsibilities among the four nations in the UK. When there is a livebirth following an abortion, or where there is uncertainty about whether there were signs of life, the coroner/Procurator Fiscal should be notified.
 Services that provide abortion care should establish close working relationships with local coroners/Procurator Fiscals to establish local pathways and to facilitate prospective discussions in situations where a livebirth after an abortion is anticipated.