NHS Foundation Trust. Early Medical Termination of Pregnancy

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1 NHS Foundation Trust Early Medical Termination of Pregnancy

2 Why choose early medical termination? Some women choose an early medical termination because it is more like a natural miscarriage and avoids anaesthesia or the use of instruments. It is associated with a lower rate of infection. Some women say they feel in control because they are aware of what is happening to their bodies. This method of termination, which is available only in the first nine weeks of pregnancy, is also known as the abortion pill. During an early medical termination drugs are used to cause an early miscarriage. One works by blocking the action of the hormone that makes the lining of the womb hold onto the pregnancy and the other, given 48 hours later, causes the uterus to cramp. The lining of the uterus breaks down and the pregnancy is lost in the bleeding that follows, as happens with a miscarriage. This method of termination requires two visits to the hospital on separate occasions, two days apart. Please have breakfast before you come in for both visits and bring with you any medication you are taking. What are the risks involved? Many women worldwide have used this treatment and it has been proven to be very effective and safe. However, every form of medical treatment has some potential risk or side effect. With this treatment the main risks, although very small are:- Excessive bleeding Incomplete termination of the pregnancy Infection Failure of treatment 2

3 The treatment is not suitable for you if any of the following apply to you:- High blood pressure High Cholesterol On long-term Cortico-steroid treatment On anti-coagulation treatment If any of these conditions apply, please inform the Nurse or Doctor at the clinic. What happens at my first appointment? You will need to attend the Gynaecology Outpatients Department (GOPD). At your first appointment, a tablet (Mifepristone) is swallowed (with water) which blocks the hormone which makes the lining of the uterus hold onto the pregnancy. A short wait of up to 20 minutes at the hospital is necessary to ensure that the tablet has been absorbed properly as you may feel a little sick. Before leaving the GOPD you will be told the date and time for your next appointment and who to contact if you have any problems or queries when you are at home. You are advised NOT to drink alcohol. Can I bring someone else? Yes, but space is limited, so please try to bring only one friend or relative with you. If you are under 16 years of age, an adult may stay with you at all times. Also, there are no facilities for children, so you will need to make alternative arrangements for child care during the time that you will be at the hospital. 3

4 What will happen between my appointments? Most women spend two days between appointments carrying out their usual activities at home or at work. During this time some women have some bleeding and period-like pains and in some women the termination itself will occur. If you do expel the pregnancy there is a chance that you might see it. The nursing staff will discuss this with you prior to commencing your treatment. Whilst at home you can call GOPD or Ward 12 for advice. Contact details can be found on page 7 of this leaflet. What happens if I change my mind and don t come to the second appointment? If you decide not to proceed with the termination after taking the Mifepristone tablet at the first appointment, you should be aware that studies done so far do not indicate that Mifepristone is associated with any increased risk of fetal abnormality. However, following Mifepristone it is unlikely that the pregnancy will continue. We strongly recommend that you complete the treatment. However, if you decide not to attend your second appointment, please contact the hospital to cancel your appointment and arrange a scan in the Early Pregnancy Assessment Unit (EPAU) to confirm the pregnancy is continuing. What will happen at my second appointment? If you choose to have the treatment as an out-patient then you need to have someone who can drive you home and stay with you overnight. The nurse will administer the medication for you vaginally. This will be carried out in the privacy of the treatment room. She will ask you to stay for approximately 15 minutes. If you feel well after this she will allow you to go home. 4

5 Side effects As well as abdominal cramps/pain there are some other side effects of the medication which include diarrhoea, nausea and fever. These tend to settle within 24 hours but if you are concerned or the symptoms persist, then please feel free to contact the GOPD or Ward 12 for advice. Not everyone will experience side effects. Analgesia We recommend that prior to having medical management you buy some simple analgesia to have at home such as paracetamol or cocodamol and ibuprofen providing that you are able to take them. Please make sure that you have some sanitary towels at home. We recommend that you do not use tampons until your next normal period. Discharge advice Once you are discharged we will ask you to repeat a home pregnancy test in three weeks time to ensure that it is negative. If it is negative you can be reassured that the process has been successful and a scan is not necessary. It is essential that if it is still positive you contact the GOPD for further advice or a review. If you feel you have not passed the pregnancy it is likely that you may do so at home over the next few days. 5

6 Sometimes you are unaware that you have passed the pregnancy as this mostly happens when you are on the toilet. You will not need to contact the GOPD routinely unless you experience any of the following symptoms: You have severe pain which is not relieved with mild painkillers You feel feverish You have excessive bleeding You have an offensive vaginal discharge If your period is later than expected and you still feel pregnant. Will my body return to normal? After an early medical termination bleeding can be irregular and prolonged (over several weeks in some cases) tailing off with spotting. If you experience continuous bleeding that is heavier than your normal period, lasting pain or abdominal tenderness or a temperature, you must see your GP at once, as these could be symptoms of an infection. Such infections are usually easy to treat, but if not treated promptly, complications could result in infertility. Your breasts may become firm and a little tender, but this will only last a day or so. You should NOT use tampons until the loss has stopped. This prevents the introduction of infection. You can use tampons during your next normal period. 6

7 When can I resume sexual intercourse? You can resume sexual intercourse once your bleeding has stopped and you should avoid unprotected intercourse. It is possible to become pregnant again shortly after the procedure. The nursing staff will discuss future contraception with you before you go home. How will I feel afterwards? Every woman is different. It is a good idea to have someone with you afterwards because you might want to talk or have some support. Women experience different feelings and cope in different ways. Some like to take a couple of days off work, others prefer not to. We would advise that you should not work on the second day of your treatment. Most women are able to return to their normal routine within a few days. Contact telephone numbers If you need advice during the treatment, please contact Gynaecology Outpatients Department on Monday to Friday 8.00 am 4.30 pm. If there is no reply please leave a message and your call will be returned. For urgent advice outside of the above hours, please contact Ward 12 on (24 hour advice). 7

8 This leaflet is available in audio, Braille, large print, and other languages. To request a copy, please telephone Gynaecology Outpatients Department Leighton Hospital Middlewich Road Crewe, Cheshire CW1 4QJ Direct Line: Printed on paper sourced from sustainable forests. IMPRESSIONS DESIGN & PRINT Reprinted June 2016 Review June 2018 Ref: WCSH/GYANE/