TERMINATION OF PREGNANCY- MEDICAL

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1 TERMINATION OF PREGNANCY- MEDICAL Information Leaflet Your Health. Our Priority.

2 Page 2 of 8 You have been offered a medical termination of pregnancy using mifepristone. You will have been given some verbal information about the procedure and what to expect during your admission. This is a written copy of that information for you to keep. Please read it carefully and we will be happy to answer any questions that you may have. What are the benefits of this method for me? A medical termination of pregnancy is a more natural method that does not involve the risks associated with a general anaesthetic. It avoids the added risk of complication which may occur when instruments are introduced into the womb for a surgical abortion, such as perforation of the womb, leading to damage of other organs i.e. bladder and bowel. The procedure can take place much earlier than a surgical abortion, as early as five weeks, meaning you will not have to wait for the procedure. You will be offered a choice of a date and time for the procedure which would be convenient to both yourself and the hospital. How does Mifepristone work? The mifepristone tablet that you will take orally, works by blocking the action of progesterone, a hormone needed in pregnancy. It is used with another drug called misoprostol, which is put into the vagina to help expel the pregnancy. What are the risks? Many women worldwide have used this treatment and it has been proved to have a very good safety record. However, every form of medical treatment has some potential risk or side effect. With this treatment the main risks although small are: Haemorrhage (excessive bleeding), around 1.2 women per 1,000 procedures. Two women in every 1,000 may require a blood transfusion and/or surgical intervention. Infection (up to 10% of all procedures). At this hospital antibiotics are given as routine which reduces this figure. Failure of method requiring a further procedure. There is no evidence to suggest that having an induced termination; (an abortion) affects a woman s future ability to have children. This treatment may not be suitable if you have any of the following: High blood pressure High cholesterol On long term corticoid-steroid treatment Anti-coagulation therapy The doctor should have discussed these with you. If you have any of these conditions, please inform the doctor or nurse as soon as possible.

3 Page 3 of 8 What happens next? After being referred for the termination, you will be seen at the hospital twice. The first visit will be only about one hour The second visit will be one, two or three days later and may take the whole day, and possibly an overnight stay, if there are any complications. However, it may be possible for you to go home after one hour if you will have someone at home with you and you do not have any pre-existing conditions that may make it unsafe for you to be at home during the procedure. You may eat and drink as normal before both appointments. Your partner or a relative or friend may stay with you throughout the procedure, but as it is not appropriate for children to be present on the unit, we request that you make necessary childcare arrangements. What will happen on my first visit? You will see friendly, helpful staff who can help you through this difficult time. Feel free to ask any questions. At this time you will have an ultrasound scan to confirm how far pregnant you are. (Please do not empty your bladder before being seen). A blood sample will be taken for routine screening. You will see a nurse and assess whether a medical termination is right for you. They will advise you about the procedure and aftercare, and check your medical details and complete the relevant documentation. You will be given one Mifepristone tablet to take with a little water. You may feel a little sick. If you vomit the tablet back within two hours of taking it you will need to return to Jasmine Ward to take another tablet. Before leaving Jasmine Ward you will be told when to come back to the ward, and who to contact if you have any problems or queries when you are at home. You are advised not to drink alcohol or smoke. If you cannot stop smoking try to smoke less on these days. What can happen between my visits to the unit? Prior to attending for your second visit you may start to bleed and experience period type pains. In most cases these symptoms are only slight and nothing to worry about. Please use only sanitary towels and NOT tampons. There is a small chance the bleeding will become excessive and you may have severe pain. It is possible that you may expel the pregnancy at this stage but this is rare. If you do expel the pregnancy there is a chance that you may see it. Nursing staff will discuss this with you before the start of the procedure. If you are worried at any time you can contact the ward for support. If you need to use pain relief we recommend that you use paracetamol or codeine as other types of medication can affect how well the mifepristone will work.

4 Page 4 of 8 Following your first visit you will be asked to return to Jasmine Ward one, two or three days later. It is very important that you keep this appointment, even if you do not think that you are pregnant anymore. What happens at my second visit? If you chose to stay in hospital for the procedure, you will be admitted to Jasmine Ward. You will expect to stay between 6 8 hours. You will be assessed about any pain or bleeding that you may already have experienced. If all is well, we will continue the treatment. To make your stay more comfortable, you may wish to bring a personal stereo, or something to read. You may eat and drink throughout the procedure and meals will be provided. If you wish a partner, friend or relative can stay with you, but please make arrangements for any children to be cared for. Vaginal tablets will be inserted into your vagina (usually by a member of the nursing staff). These tablets will help your body expel the pregnancy. You will start to bleed and experience period type pains. Women vary in reaction to this treatment. Some ladies have significant bleeding and pain, while others have minimal bleeding and pain. Most women experience moderate bleeding and pain. You may suffer from diarrhoea, sickness, headache, dizziness and hot flushes or chills, however side effects are not common. There is usually no need to worry about these, but please mention them to the nurse caring for you who will assist in relieving your symptoms. You will be asked to use a bedpan every time you use the toilet so that the nurses can check to see if you have expelled the pregnancy. You may possibly see the pregnancy whilst using the toilet. If you are uncomfortable going to the toilet on your own, please ask a nurse who will be happy to support you. If the nurses are satisfied that the termination is complete, you will be allowed home and no further follow up is required. However, if the pregnancy has not been expelled, you will be offered a further dose of medication. It the pregnancy still fails to be expelled, you will be allowed home if you are well enough to go and be advised to do a home pregnancy test in 3 weeks. If this remains positive, you will be asked to return to the unit for a further review. If you have heavy bleeding, you may need to stay overnight. If your blood group is Rhesus negative you will need an injection of Anti D. The nurse will be happy to explain this to you. You will also be given written information about this if it is required. If you choose to go home after one hour It is important that you have an adult at home with you and you are able to access emergency care if required. If you have any concerns, please contact the Jasmine Ward for advice. If you have not experienced any significant bleeding within 24 hours of having the medication, you need to contact the Jasmine Ward and attend for a further dose. If you have had significant bleeding, you are advised to do a home pregnancy test in 3 weeks. If this remains positive, you will be asked to return to the Jasmine Ward for further review.

5 Page 5 of 8 How long will I bleed after the procedure? You may bleed for 2 3 weeks following the termination. However, some women bleed less than this, whilst others may bleed until their next period. A scan maybe offered to check for any retained product of pregnancy in women who have prolonged excessive bleeding after the procedure and a further procedure may be offered. You should NOT use tampons until the bleeding has stopped. This prevents the introduction of infection. You can use tampons again when your next period comes. When can I resume sexual intercourse? We advise you that you should not have intercourse for at least a week or until you have stopped bleeding. It is possible to become pregnant again shortly after the procedure. For this reason it is important to use contraception immediately. This will have been discussed fully with you. Do I need to contact the unit following discharge? You will not need to contact the unit routinely, however if: - You have severe pain which is not relieved with mild painkillers You feel feverish. You have excessive bleeding. You have a smelly vaginal discharge. If you still have a positive pregnancy test after 3 weeks. It is important that you contact the unit or your GP within 24 hours. How will I feel after the termination? Women experience a wide range of emotions after a termination of pregnancy and sometimes a mixture of different feelings at different times. Each woman is unique and her feelings are personal to her. Most women find these feelings resolve themselves over time. Feelings of loss or sadness are common even though a woman knows she has made the right decision for her. This does not mean this decision was wrong but that it was a hard decision to make. Feelings of anger sometimes surface, and these might be directed at others, for example if a woman feels she has not been supported. Feelings of guilt or self-blame also occur, for example feelings that she may have not taken enough care or that other people are judging her. Some women feel a strong sense of relief and a sense of being unburdened. Many women feel isolated following a termination, as it is usually a very private experience and it can be hard to talk about it to other people. If you wish to discuss your feelings following the termination, please contact Jasmine Ward for advice.

6 Page 6 of 8 Discharge advice following medical termination of pregnancy For the first few days after a termination, you will experience some bleeding from your vagina; this can be heavy with clots. You are more likely to get heavier bleeding if you were later on in your pregnancy. You may also experience some cramping pains low in your abdomen. The bleeding should then decrease over the next 2-3 weeks. During this time, please use only sanitary towels as tampons may increase your risk of infection. If the bleeding is very heavy and is making you feel unwell, i.e. dizzy or light headed, or bleeding persists for longer than 14 days, you should seek advice from your GP. If this is not possible, you can contact the staff on Jasmine Ward on / 9. If the pain is getting worse or you can t relieve it with your usual pain killers, then you should also seek advice and / or treatment. This procedure carries a very small risk of infection. If you develop the following symptoms after termination, you might have an infection in your womb: A raised temperature (greater than 37 o C) Smelly vaginal discharge Pain or discomfort in your lower abdomen that is getting worse rather than better Vaginal bleeding that is increasing rather than getting better or that lasts for longer than 14 days To reduce the risk of infection, you will be given antibiotics. If you experience any of the symptoms of infection, contact your GP for advice and treatment. It is important that you don t use tampons during the bleeding following termination. You can use them again for your next period. It is not a good idea to have long hot baths shower if possible or take a quick dip in the bath. You will have been given contraceptive advice at your assessment interview. If you are going to start the contraceptive pill, you may start this today. Please do a pregnancy test in 3 weeks, if this is still positive please contact the ward. What if I need emergency contraception in the future? You can get emergency contraception from most GPs (not just your own doctor), any Family Planning Clinic or Young Peoples Clinic such as Central Youth, some GUM / Sexual Health Clinics and hospital Emergency Departments. Are there any long term complications? Most women do not have long term side effects, which could affect their ability to have children in the future.

7 Page 7 of 8 There is a very small risk of infertility in women who have an unrecognised or untreated pelvic infection. Should you have or need to ask any further questions, please phone the Jasmine Ward on / Useful contact numbers Central Youth (under 25s only) The Choices Centre (all ages) British Pregnancy Advisory Service Stockport NHS Contraception and Sexual Health Service: All clinics provide: Emergency contraception, contraceptive pills and injections, diaphragms, condoms, smear tests, pregnancy testing. Some clinics offer contraceptive implants and coils (insertions and removals by appointment).testing and treatment of sexually transmitted infections is available at some clinics. For an appointment or for further information, please ring the appointment booking line on Contact us Jasmine Ward, Women s Unit / 5509

8 Page 8 of 8 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number MAT164 Publication date October 2015 Review date October 2017 Department Gynaecology Location Stepping Hill Hospital

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