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Lithuania’s Abortion Provisions

Lithuania’s Abortion Provisions in Lithuanian

Lithuania’s Abortion Provisions in English (unofficial translation)


LIETUVOS RESPUBLIKOS SVEIKATOS APSAUGOS MINISTERIJOS
ĮSAKYMAS
1994 m. sausio 28 d. Nr. 50
Vilnius

DĖL NĖŠTUMO NUTRAUKIMO OPERACIJOS ATLIKIMO TVARKOS

Siekdamas mažinti nėštumo nutraukimo operacijų ir su jomis

susijusių komplikacijų skaičių:

1. Nustatau nėštumo nutraukimo operacijos atlikimo tvarką (1 priedas).

2. Tvirtinu motinos ir vaisiaus sveikatai bei gyvybei grėsmingų ligų ir būsenų sąrašą (2 priedas).

3. Įsakymas įsigalioja, jį paskelbus “Valstybės žiniose”.

4. Nustatau, kad Lietuvos Respublikoje nebegalioja TSRS Sveikatos apsaugos ministerijos 1982.03.16 įsakymu Nr.234 patvirtinta nėštumo nutraukimo operacijų atlikimo tvarka.

SVEIKATOS APSAUGOS MINISTRAS
JURGIS BRĖDIKIS

___________________________________

Sveikatos apsaugos ministerijos 

1994 m. sausio 28 d. įsakymo Nr.50 

1 priedas

NĖŠTUMO NUTRAUKIMO OPERACIJOS ATLIKIMO TVARKA

1. Nėštumo nutraukimas pagal moters pageidavimą.

1.1. Moteriai pageidaujant, leidžiama nutraukti nėštumą iki 12 savaičių, jei nėra šiai operacijai kontraindikacijų. Didesnį nei 12 sav. nėštumą leidžiama nutraukti, kai jis gresia moters gyvybei ir sveikatai (2 p.).

1.2. Kontraindikacijos nėštumui nutraukti:

ūmūs ir poūmiai genitalijų uždegimai,

ūmūs ir poūmiai kitos lokalizacijos uždegimai,

ūmios infekcinės ligos.

Nėštumo nutraukimo operaciją leidžiama atlikti tik išgydžius šias ligas.

 1.3. Visais atvejais nėštumas gali būti nutraukiamas tik stacionaro ginekologijos skyriuje.

 1.4. Dėl siuntimo į ginekologijos stacionarą moteris turi kreiptis į ambulatorinę pagalbą teikiantį gydytoją akušerį- ginekologą.

 1.5. Iki išduodant siuntimą nėštumui nutraukti, būtina moteriai (pageidautina ir sutuoktiniui) paaiškinti apie nėštumo nutraukimo žalą moters sveikatai, fizinę ir moralinę žalą abiems sutuoktiniams. Šią informaciją pateikia siuntimą išduodantis gydytojas akušeris-ginekologas, o pirmojo nėštumo atveju – gydytojas kartu su moterų konsultacijos vedėju. Pageidautina, kad pokalbyje dalyvautų psichologas.

1.6. Nutraukiant nėštumą nepilnametėms iki 16 metų, būtinas, o nuo 16 iki 18 metų pageidautinas raštiškas sutikimas vieno iš tėvų, įtėvių, globėjų, rūpintojų ar faktiškai jas auginančių asmenų. Sutikimą duodantis asmuo turi atvykti pats arba jo rašytinis sutikimas turi būti patvirtintas notaro.

1.7. Iki išduodant siuntimą nėštumui nutraukti, moterų konsultacijos gydytojas akušeris-ginekologas nustato nėštumo laiką ir išsiaiškina, ar nėra kontraindikacijų šiai operacijai.

Nėščiajai atliekami

bendras kraujo tyrimas, 

kraujo tyrimas dėl WAR, 

tepinėlis iš gimdos kaklelio, 

kraujo grupė ir Rh , 

  kraujo tyrimas dėl AIDS atliekamas, tik esant klinikiniams, epidemiologiniams simptomams, pacientei sutikus ar jai pageidaujant.
  Esant indikacijoms, atliekami ir kiti klinikiniai laboratoriniai bei specialūs tyrimai.
  Tyrimų duomenys įrašomi į ambulatorinę kortelę.

1.8. Siuntime nėštumui nutraukti (fNr.028/y) turi būti pažymėta: nėštumo laikas, tyrimų rezultatai, o esant medicininėms indikacijoms – susirgimas, dėl kurio gali būti nutraukiamas nėštumas.

1.9. Ginekologijos stacionare iki nėštumo nutraukimo operacijos moteris turi raštu pareikšti apie savo apsisprendimą nutraukti nėštumą.

1.10. Nėštumo nutraukimo operacijas atlieka stacionarų ginekologijos skyrių gydytojai akušeriai-ginekologai, o mikroabortus – moterų konsultacijų, kuriose įrengtos operacinės, gydytojai akušeriai-ginekologai.

 

 1.11. Ginekologijos stacionare turi būti užpildyta istorija (fNr.003-1/a), į kurią įklijuojamas siuntimas ir moters raštiškas sutikimas nutraukti nėštumą.

 Nėštumo nutraukimo operacijos registruojamos operacijų žurnale.

1.12. Nėštumo nutraukimo operacijos turi būti atliekamos tik nuskausminus.

1.13. Po pirmojo nėštumo nutraukimo operacijos, esant Rh(-), suleidžiamas antirezus D imunoglobulinas.

1.14. Apie moters išrašymo iš ginekologijos stacionaro laiką sprendžia gydytojas akušeris-ginekologas.

1.15. Po nėštumo nutraukimo operacijos gydytojas akušeris- ginekologas dirbančioms moterims gali išduoti nedarbingumo pažymėjimą ne ilgiau kaip 2 kalendorinėms dienoms. Esant komplikacijoms, nedarbingumo pažymėjimas tęsiamas taisyklėse nustatyta tvarka (žr. Nedarbingumo pažymėjimų davimo taisyklės 1991m. liepos 29 d.).

1.16. Savaiminio persileidimo ar nėštumo nutraukimo pagal medicinines indikacijas atvejais dirbančioms moterims išduodamas nedarbingumo pažymėjimas nuo pirmos nedarbingumo dienos (žr.Nedarbingumo pažymėjimų davimo taisyklės 1991 m. liepos 29 d.).

1.17. Po nėštumo nutraukimo operacijos stacionaro gydytojas akušeris-ginekologas privalo išsiųsti išrašą fNr.027/a į moterų konsultaciją, išdavusią siuntimą.

1.18. Gydytojas akušeris-ginekologas, apžiūrėjęs pacientę ir įtaręs, kad jai galėjo būti atliktas kriminalinis abortas, skubiai informuoja įstaigos vadovą, o pastarasis – prokuratūrą.

2. Kontraindikuotino nėštumo nutraukimas.

2.1. Jei dėl nėštumo motinos gyvybei ir sveikatai gresia pavojus, jis nutraukiamas, neatsižvelgiant į nėštumo laiką (Motinos ir vaisiaus sveikatai bei gyvybei grėsmingų ligų ir būsenų sąrašas 2 priede).

Nėštumas nutraukiamas tik atsiradus realiai grėsmei motinos sveikatai ir gyvybei. Rekomenduotina nėštumą nutraukti iki 12 nėštumo savaičių.

2.2. Grėsmingų motinos ir vaisiaus gyvybei bei sveikatai ligų ir būsenų atvejais fertilinio amžiaus moterys turi būti dispanserizuotos. Norinčios gimdyti moterys turi būti nuodugniai ištirtos prieš pastojant. Nėštumo planavimo, tęsimo, ilgalaikės kontracepcijos priemonių parinkimo, kai nėštumas kontraindikuotinas, klausimus sprendžia gydytojų komisija. Ji įvertina ir indikacijas nėštumui nutraukti.

2.3. Gydytojų komisijos veikia Vilniaus universitetinėje moterų klinikoje, Kauno medicinos akademijos akušerijos- ginekologijos klinikoje, Klaipėdos m. ligoninėje, Šiaulių ir Panevėzio respublikinėse ligoninėse.

Gydytojų komisijos pirmininku turi būti skiriamas akušeris- ginekologas. Be jo, į komisiją turi įeiti terapeutas, neuropatologas ir kviečiamas gydytojas specialistas pagal ligos profilį. Komisijos pirmininkas skiriamas, suderinus su perinatologijos centrų vadovais.

Su gydytojų komisijos sprendimu moteris supažindinama pasirašytinai. Gydytojų komisijos išvada dėl nėštumo nutraukimo pagal medicinines indikacijas turi būti patvirtinta komisijos narių ir jos pirmininko parašais bei gydymo įstaigos antspaudu. Išvada surašoma į dokumentą Nr.27. Psichikos ar veneros ligų atvejais šis dokumentas perduodamas į akušerijos-ginekologijos stacionarą tiesiogiai.

2.4. Diagnozavus nesuderinamą su gyvybe vaisiaus apsigimimą, nėštumas gali būti nutraukiamas, tik išaiškinus moteriai (pageidautina ir sutuoktiniui) galimas priešlaikinio nėštumo nutraukimo pasekmes motinos sveikatai.

2.5. Ilgesnis nei 12 savaičių nėštumas pagal medicinines indikacijas nutraukiamas Vilniaus ir Kauno perinatologijos centruose.

2.6. Moterys nėštumui nutraukti pagal medicinines indikacijas vežamos respublikinių ligoninių transportu.

3. Visais atvejais nėštumui nutraukti būtinas moters (pageidautinas ir sutuoktinio) sutikimas.

4. Kontraindikuotino nėštumo nutraukimo operacijos atliekamos nemokamai, kitais atvejais yra apmokamos pagal Sveikatos apsaugos ministerijos nustatytus įkainius.

Pastaba. Nėštumo nutraukimo operacijos atlikimo tvarkos privalo laikytis ir privačia praktika besiverčiantys gydytojai akušeriai- ginekologai.

MOTINOS IR VAIKO SVEIKATOS APSAUGOS SKYRIAUS VIRŠININKĖ
V.VAINAUSKIENĖ


ORDER No. 50 of 28 January 1994 of the MINISTRY OF HEALTH OF THE REPUBLIC OF LITHUANIA, Vilnius, ON PROCEDURES FOR PERFORMING A SURGICAL TERMINATION OF PREGNANCY

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 to 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
V. VAINAUSKIENĖ

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