Pregnancy Advisory Service

Transcription

1 14 Pregnancy Advisory Service The James Cook University Hospital Patient Information Women and Children - Gynaecology

2 The pregnancy advisory service Initial consultation with this service are held at both The James Cook University Hospital, Middlesbrough and the Friarage Hospital, Northallerton. There are various agencies for advice and support if you feel you need it: Alcohol Abuse Drug Abuse Domestic Violence Teenage Help Lines Smoking GUM Clinic And many more. If you do have any concerns please confide in the nurses at any time during your treatment. What is an abortion? An abortion is a means of ending a pregnancy and may be necessary for a number of reasons, many of which are personal. Your reasons for the abortion will not be judged and our staff members are here to support you. If you are under sixteen years of age, the nurse must feel that you are fully aware of the way the termination will take place and you understand what risks may be involved before she can start the treatment. It may be that the nurse will require a signature from your next of kin or a responsible adult (over 18 years of age). Medical abortion A medical abortion is a means of ending a pregnancy without the need for an operation or anaesthetic. It involves taking tablets that will result in the miscarriage of the pregnancy. Possible complications: There is a 3% chance of miscarriage after taking the first part of treatment and before admission for the second part. Less than 1% of pregnancies under nine weeks and up to 4% of pregnancies between nine and eleven and a half weeks fail to terminate with the first treatment. If all the products of conception are not expelled and you retain placental tissue, you may require an operation to have this removed. Approximately one in one thousand women require a blood transfusion due to blood loss. Infection may occur. You may experience emotional trauma, which may be immediate or delayed. Every care is taken to ensure the risks are minimal. What does the treatment involve and how does it work? You may bring a friend or relative with you to your first appointment and this first visit will include a scan to determine how many weeks pregnant you are, occasionally this will be done vaginally. This will be followed by a consultation with a nurse. Both the scan and consultation will take place in private without your accompanying friend / relative being present. After the initial discussion have taken place, one friend / relative may be invited into the consultation room should you wish. You will be given time and dates for your treatment which is in two parts. 2 3

3 First part of treatment: You will be issued with an antibiotic suppository for you to take home and the nurse will give you instructions on how to insert it. This part of the treatment is very important, to help prevent infection. You can also have a chlamydia test sent at this time, should you wish. You will be given a tablet to take by mouth. Legally, this must be taken in front of the nurse. This tablet blocks the action of a hormone called progesterone and without this hormone, the lining of the womb starts to break down. As a result of taking this tablet, your body may sense a miscarriage starting. You may experience an increase in nausea, some discharge or bleeding and some period type cramps. If you need to take painkillers at home, paracetamol should be enough. Do not take painkillers that contain aspirin, such as Ibuprofen, as these will affect your treatment. Use sanitary towels, (not tampons) for any bleeding before and up to six weeks after treatment. You are advised not to take alcohol or smoke from the start of your treatment, (the first tablet), until four days afterwards. Second part of treatment: The second part of the treatment takes place two days later. This involves admission to hospital. This can be for up to eight hours for a first trimester, (11 1 /2 weeks pregnant and under) and up to three days for a second trimester, (11 1 /2 weeks pregnant and over). Hormone tablets called misoprostol are given. These hormone tablets encourage the neck of the womb, (cervix) to soften, relax and open and the muscles to contract. These contractions can feel like strong period pains and vary in severity according to individual patients. The nurse will give you painkillers if required. It is best to request them as soon as you feel uncomfortable as some painkillers take time to get in your system and work. If you wish you may bring a hot pack (not a hot water bottle and not a hot pack that requires heating in a microwave). The extent of bleeding will vary from person to person. Please bring at least two packets of thick sanitary pads. Also bring a few changes of comfortable clothing as you may mark your clothing when you bleed. The pregnancy products are collected using disposable bedpans; these bedpans will be shown to you on admission. Unfortunately we cannot guarantee you will not see the pregnancy products and from eight weeks the fetus is recognisable. The medication may cause you to experience diarrhoea, nausea or vomiting, hot or cold flushes, dizziness. You are allowed one escort only. Please do not bring more than one as they will be refused entry. Under no circumstances are children allowed. You must arrange suitable childcare prior to admission. This part of the treatment works better if you mobilise regularly. You are encouraged to go for a walk every halfhour. Pregnancies under nine weeks: Your medication (four tablets) is self inserted vaginally on admission. Pregnancies between nine and 11 1 /2 weeks: Your medication (four tablets) is self inserted vaginally on admission. Three hours later, if products not passed, two more tablets are taken by mouth. If the treatment fails you will need a new plan of care and the nurse will arrange this. 4 5

4 Pregnancies of 11 1 /2 weeks and over: Your medication (three tablets) is self inserted vaginally on admission. Every three hours thereafter, you will be given two tablets by mouth until you have passed the fetus and placenta or you have taken the maximum five doses in twenty-four hours. You may notice a mucous discharge and a sudden gush of watery fluid. This is the fluid that surrounds the fetus in the womb and comes away in preparation for the miscarriage. You may notice a feeling of heaviness and pressure in your lower abdomen. After this it is usual to pass the fetus and placenta. If the abortion does not occur, you will need to stay in hospital overnight, possibly two nights, so please bring nightwear and toiletries. What about afterwards? You will continue to bleed for approximately six weeks. This can be heavy with clots at first with period type cramps. You may take paracetamol if required (not aspirin based drugs). You may get tender breasts and nausea may continue. This is because it takes time for the pregnancy hormones to leave the body. (You are advised to see your GP if you have symptoms of infection i.e. heavy bleeding with clots that you do not feel is a period, a raised temperature and flu like symptoms). To help avoid infection, do not use tampons and do not have sexual intercourse for six weeks (or until after first period). You will need to take advice if sickness and breast tenderness continue for more than two weeks after the termination. What about contraception? Most women attend this clinic as a result of condom failure. We would recommend a combination of condom and another method. You should access contraception via your GP or the Sexual Health and Contraception Service (Family Planning Clinic). What happens to the fetus afterwards? All fetuses are handled in a sensitive manner. It is our normal practice to cremate fetuses at a crematorium with involvement of the hospital chaplain. Should you wish to discuss alternative arrangements, please speak to a member of staff. What if you change your mind? You must not take the first tablet if you have doubts about your decision to terminate your pregnancy. Little is known of the effects of the abortion tablet on a developing pregnancy. The staff are here to talk to if you require more time for your decision or you wish to cancel the termination altogether. First part of treatment Date:... Time:... Place: Lilac Suite Second part of treatment Date:... Time:... Place: Lilac Suite To find the Lilac Suite, go in the hospital s Bridge entrance and along the ground floor corridor, turning right at the sign for Ward 27. This short corridor will take you to the doors of Ward 27 on the left hand side. The Lilac Suite is through the first door on the left inside Ward

5 We hope you have found this information helpful. Please remember our staff will be happy to answer any questions you have about any aspect of your care and welcome any comments about this leaflet. Pregnancy Advisory Service - Lilac Suite: Appointments Desk: Gynaecology Ward 27: Sexual Health Teesside: sexualhealth.teesside@nhs.net Gynaecology Outpatients Department: Comments, compliments, concerns or complaints South Tees Hospitals NHS Foundation Trust is concerned about the quality of care you receive and strives to maintain high standards of health care. However we do appreciate that there may be an occasion where you, or your family, feel dissatisfied with the standard of service you receive. Please do not hesitate to tell us about your concerns as this helps us to learn from your experience and to improve services for future patients. Patient Advice and Liaison Service (PALS) This service aims to advise and support patients, families and carers and help sort out problems quickly on your behalf. This service is available, and based, at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services. Please ask a member of staff for further information. All information contained in this booklet, as advised by: The Pregnancy Advisory Service Medical and Nursing Team The James Cook University Hospital Marton Road, Middlesbrough, TS4 3BW. Tel: Version 7, Issue Date: November 2014, Revision Date: January 2016 MICB3095