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Abortion
>> Abortion >> Early Medical >> Surgical >> Aftercare >> UK Law >> Facts and Figures	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 tablet which contains a hormone called prostaglandin; prostaglandins occur naturally in the body and help the uterus to contract. 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 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 the treatment 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&C (diletation & curettage - 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 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 Medical notes - if you have already had a consultation elsewhere 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 pre-treatment blood test (if this has not already been done). You may have a scan. It is more difficult to detect an early pregnancy if your bladder is not full. 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. After being admitted, a nurse will show you to a room and will confirm your medical details. She will check your blood pressure, temperature and pulse and discuss your treatment with you. 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 1 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. During treatment: Aspirin and any medication containing aspirin should be avoided until after the insertion of misoprostal (ie. don't take these during the mifepristone phase); aspirin can make you bleed more. You can take paracetemol or ibuprofen straightaway for pain relief. Are there any side effects? After the first stage of treatment, you may experience the following: Bleeding and passing of clots Feeling faint or a little nauseous Headaches and skin rashes may occur Miscarriage may occur in rare cases before the second tablet. You may experience heavy cramp-like period pains. You must still attend the Clinic for your planned second appointment so that we can check that everything is all right. You may feel free to take any pain relief in this case (see above). 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. Relatives can request a consultation with the doctor if they wish. We have a waiting room with refreshments for relatives and friends. Second visit After your first visit, you will be asked to return to the Clinic (between 1-3 days, whatever is convenient for you). It is very important that you keep this appointment. Have a light breakfast (tea and toast is fine), before 10am, on the morning of your second visit. 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 and kept in position by a tampon. 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. If you need painkillers, your nurse will provide them. You can leave the Clinic after half an hour. However, you should take it easy for a couple of hours. After this, you may find that moving about will ease any discomfort. Treatment lasts between 4 - 6 hours following the insertion of the tablet. During this time, the miscarriage is usually completed. However, in some cases the miscarriage can take place earlier or later. Discharge from the clinic You may bleed heavily following the second visit, usually for 2 - 3 days. This is quite normal. After this time, the bleeding will lessen but you could bleed on and off for 3 - 4 weeks. You will be given an aftercare information sheet by the nurse. Post procedure 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 the termination; please remember to take them. Your first period may occur 4 - 6 weeks later and it may be heavier than normal. No follow-up will be needed but if you have any problems they can be discussed with the Clinic, your local Pregnancy Advisory Service, Family Planning Clinic or your GP. If you develop any unexpected symptoms or reactions that you are not sure about, please contact the Clinic and discuss your symptoms with a nurse. If 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. Please ring the Clinic if you are concerned. 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.

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