• Reference Number: HEY1000/2018
• Departments: Gynaecology
• Last Updated: 16 July 2018

Introduction

This leaflet has been produced to give you general information about medical termination of pregnancy. Most of your questions should have been answered by this leaflet.  It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion.   If after reading this leaflet you have any concerns or require further explanation, please discuss this with a member of the healthcare team who has been caring for you.

The Pregnancy Advisory Service is a confidential service and any information disclosed during your visit will not be shared unnecessarily (please see the back page of this leaflet for further information).

What is a medical termination?

A medical termination is where you take a medicine which will end the pregnancy. The medical name for the medicine is mifepristone. It works by blocking the hormone progesterone. Without progesterone, the lining of the uterus breaks down and the pregnancy cannot continue.

Why do I need a medical termination?

You have opted to have a medical termination to end your pregnancy.

Can there be any complications or risks?

Many women worldwide have used this treatment and it has proven to have a very good safety record. Every form of medical treatment has some risk or side effect. With this treatment the main risks, though small are:

Excessive vaginal bleeding, such that you may need a blood transfusion, happens in around 1 in every 1000 termination of pregnancy.

Should complications occur, treatment – including surgery – may be required.

Are there risks after the medical terminal of pregnancy?

You are more likely to get problems in the 2 weeks after the termination of pregnancy than at the time of the procedure itself:

Up to 1 in 10 women will get an infection after a termination of pregnancy. Taking antibiotics at the time of the medical termination of pregnancy helps to reduce this risk. If you are not treated, it can lead to a more severe infection known as pelvic inflammatory disease (PID).

The uterus may not be completely emptied of its contents and further treatment may be needed. This happens in fewer than 6 in 100 women having a medical termination and in 1 to 2 in 100 women having a surgical termination. An operation may be needed to remove the pregnancy tissue within the uterus.

Short-term emotional distress is common, but only a small amount of women experience any long-term psychological problems. This risk has to be balanced with the risks of the psychological problems that may occur if the pregnancy continues. You can access a counsellor leading up to and following your termination of pregnancy, if you feel you require emotional support or help in decision making.

The risks of developing either breast cancer or fertility problems (difficulty in getting pregnant again) following a termination of pregnancy have not been proven. However a small number of research studies have identified a slightly higher risk of miscarriage or early birth (source of information relating to risks is taken from the Royal College of Obstetricians and Gynaecologists, Guideline 7, 2011: www.rcog.org.uk/understanding-how-risk-is-discussed-healthcare.)

An untreated, infection can cause fertility problems and so it is essential that you take all antibiotics prescribed and follow the post operative care and advice as given to you by your nurse/doctor, which includes contacting your doctor/GP if you have any problems following your treatment.

What are the risks of the termination of pregnancy failing?

All methods of early termination of pregnancy carry a small risk of failure to end the pregnancy and therefore a need to have another procedure. This is uncommon, occurring in less than 1 in 100 women, this is higher in early discharge.

How do I prepare for the medical termination?

Please read the information leaflet. You may share the information it contains with your partner and family (if you wish) so that they can be of help and support. There may be information they need to know, especially if they are taking care of you following this procedure.

You should be offered extra support, including counselling if you want it, to help you make your decision. You should be offered information and support if you decide not to have a termination. Your healthcare team should ensure that you can get help if you have additional needs.

You have the right to delay or cancel appointments. You can also change your mind about having a termination at any stage. If you do change your mind please contact Gynaecology Outpatients on (01482) 607829.

Who is it not suitable for?

Medical termination of pregnancy with mifepristone, as an outpatient is not suitable if any of the following apply to you:

• High blood pressure.
• Diabetes.
• High cholesterol.
• Some steroid treatments.
• Anti-coagulant treatment.
• If you smoke more than 20 cigarettes per day and are over 35 years old.
• If you are 9 or more weeks pregnant.
• If you are breastfeeding.
• If you have either severe liver, kidney or chest disease.
• If you have an IUS or IUD (‘coil’) in place.

These should have been discussed with you at the clinic. If you have any of these conditions please inform the doctor or nurse.

You have to be prepared to go through with the full termination procedure once mifepristone is swallowed. This is because of the risks the drugs may have to the developing fetus, causing abnormalities, if the pregnancy continues.

What will happen?

The medical termination of pregnancy takes place over two visits to the department (24 or 48 hours apart).

Visit 1

You may have breakfast before you come in for both visits. However we prefer you not to eat or drink for one hour prior to your visit.

You will be welcomed to the department by a nurse who will confirm with you that your personal details are correct. The nurse will then check your blood pressure and will discuss your treatment with you. This is to repeat the information you received during your previous outpatient visit and to answer any additional questions you may have. It is important that you let the nurse know if you are at all unsure about the care you will receive during the procedure or at all unsure about proceeding with treatment.

The nurse will also check that your health status have remained unchanged since your last consultation. The nurse will check your consent form to confirm you wish to proceed.

You will be given a mifepristone tablet to swallow with some water – this is the point beyond which you cannot change your mind.

Sometimes the mifepristone tablet can make you feel sick, and so we ask you to stay in the department for half an hour after taking the tablet. You will be told when to come back to the department for your second visit.

If you are sick within two hours of leaving the department, please phone for advice.

You may start to bleed and have a period type pain prior to attending the hospital for the second part of the procedure. There is a small chance that you could expel the pregnancy at this stage, although this is not very likely. This may be like a heavy period, use a sanitary towel if this occurs, please do not use tampons if you start to bleed.

You are advised to take medication such as ibuprofen or paracetamol to relieve any pain you get. Only take those recommended by staff until two days after all bleeding has stopped. You must also avoid alcohol and smoking until treatment is complete.

If you are worried please telephone: Gynaecology Outpatients 8am till 6pm (01482) 607829 or Ward 30 (01482) 604387 outside of these hours.

Visit 2

The second visit lasts longer than the first and you may want to bring something to occupy yourself (e.g. a book, magazine, MP3 / iPod). For the privacy and comfort of you and other patients we request that you be accompanied by only one adult friend/carer during your second visit. Please do not bring children with you.

You will be more comfortable if you wear light, loose fitting clothes.

On return to the Gynaecology Outpatients department, you will be asked about any pain or bleeding you may have had over the last two days. If you have had any symptoms please inform the staff now. If all is well the procedure will continue.

To encourage the womb to contract and expel the pregnancy, you will be asked to keep some tablets (misoprostol) in your mouth, between your cheek and gums, for 20 minutes before swallowing what is left. Soon after this, you may begin to experience a period type pain and some vaginal bleeding. A nurse will be available throughout your stay and will provide you with pain relief medication if you need this. The nurse will also provide support and companionship.

Uncommonly, you may experience diarrhoea, sickness, headache, dizziness and hot flushes/chills. Let your nurse know straight away and she will help you to cope with these symptoms. There is no need to be worried about these.

You will have to stay in the department for up to six hours following the tablets. By this time the termination of pregnancy should be complete. However if the procedure is not underway, you may be given a repeat dose of the tablets.

Very occasionally the termination may happen after you have left the unit and rarely (only one case in every 300) the pregnancy will continue.

During your second visit to the department you do not have to lay down on a bed and will be able to move around as you wish. You will be asked to use a receiver every time you use the toilet, so the nurse can assess if the medical termination of pregnancy has taken place.

Light refreshments will be offered to you during your stay; tea, coffee and soft drinks are available at all times.

At the end of the procedure the nurse will check that you are well enough to go home. You can eat and drink normally. If you have experienced heavy bleeding or persistent pain we may advise you to stay in hospital overnight, until any problems are resolved. This should be born in mind as regards to making family arrangements.

A responsible adult who knows what procedure you have had should accompany you home and stay with you overnight.

One adult only to accompany you on your second visit.

What happens afterwards

Follow up information

We recommend you have a routine checkup in 4-6 weeks. This is to ensure you are recovering physically and emotionally from today’s procedure. If you are well, you will not need an internal examination (unless you have a “coil”). This checkup can be with your family doctor, a family planning clinic or at the clinic here in the Women and Children’s Hospital, Hull Royal Infirmary.

If you would prefer to have your check up at the hospital clinic or if any problems arise in the months following the procedure and you would like to be seen, you can arrange this yourself by ringing (01482) 607837 and saying you need a DC4 appointment. This will ensure you are given an appointment within the next week.

Discharge advice

You may continue to bleed for at least two weeks following the termination. You may also require mild pain relief medication (such as ibuprofen or paracetamol). Please do not use tampons until your next period. Do not resume sexual intercourse until all bleeding has stopped.

NB if you feel ‘fluey’, develop an offensive discharge, persistent and increasing tummy or generalised pain, a high temperature or fever, or any increase in bleeding please contact your GP to be seen urgently, as this may indicate an infection which will need further treatment to prevent future complications.

Your blood will have been tested before your termination. If you have a rhesus negative blood group, you will be given an injection immediately after your procedure to prevent the formation of antibodies that might otherwise cause problems in future pregnancies.

You will be given 2 antibiotics routinely unless you are allergic to them. This is given as tablets or as a suppository into your back passage (bottom).

Contraception: It is possible for you to become pregnant straight away following termination of pregnancy, so you must start using contraception straight away. You may have already decided what contraceptive you would like to use after the termination. You will be given the opportunity to discuss your needs again either prior to, or following, your procedure. If you wish to have an intra-uterine device (coil) fitted, the implant (Nexplanon), or start the contraceptive injection, this can be done immediately after the termination has taken place. If you wish to use oral contraception (the pill) or contraceptive patch (Evra), a starter pack will be given to you before you leave the hospital.  You must start them the day after the procedure.  The nursing staff are happy to discuss other forms of contraception with you including male and female sterilisation.

Telephone Calls: To ensure confidentiality, you should discuss any specific arrangements made with regards to incoming calls with the nurse who admits you onto the ward.  Your nurse will ensure she adheres to these arrangements, should anyone ring to enquire about your condition.  However, you are responsible for whom you inform about your admission and what you tell them about what you are being admitted for.

Sexual Health:  You may be at risk of getting a sexually transmitted infection if you do not practice safe sex and use condoms.  Your nurse will provide you with a supply of condoms upon discharge home.

Counsellors:  You can access counsellors through the Pregnancy Advisory Service from referral into the service or upon attending the department for an appointment.

Pregnancy remains:

These are the choices available to you:

1. The hospital will arrange a shared cremation with your consent; this is carried out at the crematorium in a sensitive and respectful manner by the hospital chaplain.  You may choose to know the date when this will occur and may wish to attend the service and these details can be provided for you. Your pregnancy remains will be stored at the hospital in a safe and secure place up to a period of 12 weeks after the procedure.  Details of the mother remain confidential and are not provided to the crematorium. Following the cremation there are no individual ashes, the joint ashes are scattered or buried in the Cemetery at the Chanterlands Avenue Crematorium.
2. However, you may wish to have an individual cremation/burial. You can organise a cremation yourself by contacting a funeral director of your choice or Hull Bereavement Services. The hospital is unable to contribute to the cost, however many funeral directors make a nominal charge or do not charge for their services in these situations.
3. If you are unsure of your wishes for your pregnancy remains you can contact the hospital within 4 weeks of your procedure.  The date that you must let us know by will be documented on your consent form. The contact telephone numbers are Gynaecology Outpatients (01482) 607829, Cedar Ward (01482) 604387 and EPAU (01482) 608767.
4. In all cases the staff will ensure that your cultural and/or religious needs are respected.
5. You are also legally allowed to take your pregnancy remains home to bury yourself.  There are certain legal requirements that must be adhered to if you wish to do this, which are as follows:

• The burial must not cause any danger to others.
• It must not interfere with any rights other people may have on the land.
• There must be no danger to water supplies or watercourses.
• There must be no chance of bodily fluids leaking onto adjoining land.
• The remains must be buried to a depth of at least 18 inches (45cm).
• Permission must be obtained from the landowner if you do not own the land.
• Careful thought needs to be given when considering burial in a garden, taking into account what would happen if you choose to move.

What are the long-term effects of termination of pregnancy?

How may I be affected emotionally?

For most women the decision to have a termination is not easy. How you react will depend on the circumstances of your termination of pregnancy, the reasons for having it and how comfortable you feel about your decision. You may feel relieved or sad, or a mixture of both. Most women will experience a range of emotions around the time of the decision and the termination of pregnancy procedure. The majority of women who have termination do not have long-term emotional problems; long-term feelings of sadness, guilt and regret appear to linger in only a minority of women. Talk to your doctor if you do have any concerns. A termination will not cause you to suffer emotional or mental health problems in itself, but if you have had mental health problems in the past you may experience further problems after an unplanned pregnancy. These problems are likely to be a continuation of problems experienced before and to happen whether you choose to have a termination of pregnancy or to continue with the pregnancy.

Will a termination of pregnancy affect my chances of having a baby in the future?

If there were no problems with your termination, it will not affect your future chances of becoming pregnant.

Will a termination of pregnancy cause complications in future pregnancies?

A termination of pregnancy does not increase your risk of an ectopic pregnancy or a low placenta if you do have another pregnancy. However, you may have a slightly higher risk of a miscarriage or premature birth.

Useful contacts and websites

Finally, if you wish to discuss any aspect of your care, or if you have any worries or change you mind about having the termination, you can contact:

Gynaecology Outpatients, Women and Children’s Hospital – (01482) 607829.

Information on The Pregnancy Advisory Service can be found at:
www.hey.nhs.uk/gynaecology/pregnancy-advisory-service.

The Hull and East Riding Sexual and Reproductive Healthcare Partnership.
Website: conifersexhealth.co.uk.

Family Planning Association.
Website: www.fpa.org.uk.

British Pregnancy Advisory Service.
Telephone: 08457 304030.
Website: www.bpas.org.

Marie Stopes Organisation.
Telephone: 0845 3008090.
Website: www.mariestopes.org.uk.

Royal College of Obstetricians and Gynaecologists.
Website: www.rcog.org.uk.

Admission details

You need to attend Women and Children’s Hospital on:

Place, Date and time of Visit 1 _____________________

Place, Date and time of Visit 2 _____________________

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.