Early Medical Abortion

Early medical terminations are available up to 9 weeks of pregnancy. This is where drugs are used to induce an abortion. You will need to visit the Clinic on two separate occasions (for admission/consultation and to take two separate tablets: mifepristone and misoprostal).

Treatment

The mifepristone tablet works by blocking the action of progesterone, a hormone needed to maintain the pregnancy. Mifepristone is taken orally and acting together with misoprostol tablets will bring on an abortion. Misoprostal is a vaginal pessary which contains a hormone called prostaglandin; prostaglandins occur naturally in the body and help the uterus to contract and expel the products.

Many women around the world have used this treatment and it has been shown to have a very good safety record. However, every form of medical treatment carries some risks or side effects. With this treatment, the main risks, though very small, are excessive vaginal bleeding, incomplete abortion and infection and, rarely, allergic reactions. These are usually treated very easily.

This kind of medical termination of pregnancy may not be suitable for you if any of the following apply:

You have been on long term corticosteroid treatment
You are on any anticoagulant (blood clotting) treatment
You have had a bad reaction or are allergic to mifepristone
You have liver or kidney disease
You have a history of cardio-vascular disease
You have risk factors for heart disease (such as high blood pressure or high blood cholesterol levels
You suffer from asthma
You suffer from any other disease or illness and are taking other medication
You have an IUD in place which may need to be removed prior to the beginning of treatment
You are breast-feeding (we do not recommend use of mifepristone in women who wish to continue breast-feeding because the drug will pass into breast milk. It takes around 26 days for the drug to clear the body)

If any of these conditions apply, please inform the doctor/nurse who will discuss them with you.

Very rarely the procedure may fail to terminate the pregnancy. If there is any doubt you will be asked to return for a check visit where a scan will be performed. A further course of treatment is available or you may prefer to have a medical D&E (dilatation & evacuation - a small surgical procedure to remove any retained products of conception if the termination is not complete).

Ectopic pregnancies

Occasionally, pregnancies form outside the womb in the fallopian tubes; they are called ectopic pregnancies. They occur in about 1 in 200 pregnancies. Medical abortion is not effective in an ectopic pregnancy and, in this case, a woman would need to undergo a different treatment. As the pregnancy progresses, a woman may experience constant pain, usually on one side only, a bloody discharge and a positive pregnancy test. If an ectopic pregnancy is diagnosed, you will be referred to a hospital as an emergency.

First visit:

Please remember to bring:

A referral letter with you - if referred from the doctor
Medication - any that you take routinely
Blood transfusion card - if you have one

When you arrive, the administration staff will check that all your records are in order. Then the Clinic nurse will perform a simple finger prick blood test (if this has not already been done). You will have a scan. It is more difficult to detect an early pregnancy if your bladder is empty. Therefore, as your pregnancy is less than 9 weeks, it is very important to arrive with a full bladder or not go to the toilet until advised by the Clinic staff.

You will then see a doctor who will discuss your medical details with you and sign the consent for treatment. After being admitted, a nurse will show you to a room and will confirm your medical details and the treatment you are going to have. She will check your blood pressure, temperature and pulse, discuss your treatment with you as well as answer any queries you might have.

If your blood group is Rhesus negative, we will give you an injection called Anti-D to prevent antibodies forming against a future pregnancy.

You will be given a mifepristone tablet to swallow with some water. It is important to keep in mind that taking the mifepristone is the abortion. It starts a process which cannot be stopped or reversed later.

After taking the tablet, we ask that you stay at the Clinic for up to half an hour so that we can check that you are all right. During this time, as long as you feel well, you will be given refreshments. Before you leave the Clinic, you will be given your next appointment time and who to contact if you have any queries or problems.

Are there any side effects?

After taking the first tablet, you may experience the following:

Bleeding and passing of clots
Feeling faint or a little nauseous or vomiting*
Headaches and skin rashes may occur
Slight dizziness or feeling feverish
You may experience heavy cramp-like period pains
Miscarriage may occur in rare cases before the second tablet

You must still attend the Clinic for your planned second appointment since we cannot be sure you have passed the pregnancy sac; therefore we need to continue with the second treatment. You may feel free to take any pain relief in this case.

* If you vomit within 2 hours of taking the mifepristone, please contact the Clinic and speak to a nurse; you will have to start the treatment again.

Can I change my mind after the first treatment?

It is inadvisable for you to change your mind once the first tablet has been taken. If the pregnancy continues the baby may be born with abnormalities.

Relatives and friends

We do need to see you alone for your treatment. A friend or relative may accompany you at consultation with the doctor if you wish. We have a waiting room for relatives and friends.

Second visit

After your first visit, you will be asked to return to the Clinic (between 6 hours - 3 days, whatever is convenient for you). It is very important that you keep this appointment.

You will be taken to a room and any symptoms that you may have experienced since your first appointment will be discussed with you. If all has been well, your treatment will continue. There is a waiting room for relatives and friends while you are having treatment.

Misoprostal tablets will be inserted into your vagina by self-administration/nurse. The misoprostal helps your body expel the pregnancy so you will start to bleed and experience period-like pains. All women react differently to this treatment. Some have heavy bleeding and quite a lot of pain, while others have very little bleeding and mild pain. And most women are in between the two. However, it is important to remember that this is not a completely pain-free procedure. You will be given pain relief prior to the insertion of the misoprostal.

You may experience the following:

Nausea or vomiting
A feeling of light-headedness
Feeling feverish
High temperature
Diarrhoea

You can leave the Clinic after the treatment. However, you should take it easy for a couple of hours. After this, you may find that moving about will ease any discomfort. For women travelling from overseas, we strongly recommend that you stay in the area overnight before travelling home.

The abortion usually takes place between 4-6 hours following the insertion of the tablet. However, in some cases, the abortion can take place earlier or later.

Discharge from the clinic

You may bleed heavily following the second visit, usually for 2 - 3 days; you may even pass some clots. This is quite normal. After this time, the bleeding will lessen but you could bleed on and off for 3 - 4 weeks.

If you are concerned, you can always phone the Clinic.

Post procedure

Before you leave the Clinic after your second visit, the nurse will arrange a convenient time and telephone number so that we can call you after your second treatment. This is so we can check that you are all right and that the abortion is complete.

You can take your normal painkillers to relieve any discomfort; do not take more than 2 in 4 hours.
You will have been given antibiotics to take after treatment; please make sure that you take them.
Your first period may occur 4-6 weeks later and it may be heavier than normal.
You should refrain from sexual intercourse for 3 weeks after the treatment to reduce the risk of infection.
We also advise that you avoid any heavy lifting or exercise for 2-3 weeks
Use sanitary towels instead of tampons until your next regular period to avoid the risk of infection.

No follow-up will be needed but if you have any problems, they can be discussed with the Clinic, your GP or your local Family Planning Service. You can do a pregnancy test 4 weeks after treatment to put your mind at ease; don’t do one any earlier because you can still get a positive result.

If you develop any unexpected symptoms or reactions that you are unsure about, please contact the Clinic and discuss your symptoms with a nurse. If the symptoms do not subside following our telephone advice, we can arrange for you to come in and see a doctor.

If you have had the Depo Provera injection, you could bleed intermittently after the second tablet.

Driving

1st visit - you can drive before and after treatment 2nd visit - we recommend you arrange to be collected and have someone with you (or nearby) overnight.

Contraception

You are still fertile and at risk of another pregnancy. It is therefore important that you use reliable contraception. You can start the combined or progesterone-only Pill immediately after the second visit. If you do start the Pill, your next ‘period-like' bleed is likely to be sometime during your week break. Please start your next packet as instructed. Remember to use an alternative method of contraception (eg. condoms) because antibiotics can make the Pill ineffective.

Long-acting reversible contraception (Depo Provero or Implanon) can be given at your second EMA appointment.

Calthorpe Clinic, 4 Arthur Road, Edgbaston, Birmingham B15 2UL