Surgical Termination of Pregnancy (Local and General Anaesthetic)

  • Reference Number: HEY-284/2018
  • Departments: Gynaecology

Introduction

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).

This leaflet has been produced to give you general information about your surgical termination of pregnancy. Most of your questions should be 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 it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

Information before surgical termination of pregnancy

Some women will be offered a local anaesthetic surgical termination if they are suitable and this procedure can then be performed in the Outpatient department. If you are not suitable for a local anaesthetic it will be performed under a general anaesthetic as a day case procedure and therefore you should be able to go home on the same day as the operation. If you have underlying medical conditions, some women are booked into hospital overnight.  However, you will be assessed by a nurse/doctor prior to your discharge home and very occasionally you may be required to stay overnight, for example, if you have a lot of pain or very heavy bleeding.  It is important for you to bear this in mind when making arrangements for your discharge.

Advice will be given in clinic by the doctor/nurse if you need to omit medications prior to being nil by mouth for surgical termination under general anaesthetic.

A responsible adult must accompany you home from the hospital and stay with you overnight.  The person taking you home should ring the ward before coming to ensure you are well enough to go home.

What is a surgical termination of pregnancy?

Surgical termination of pregnancy involves a minor operation. A vacuum aspiration using gentle suction will be used to remove the pregnancy and takes approximately 5-10 minutes from start to finish.  This can be done either with you awake (under local anaesthetic) or asleep (under general anaesthetic) depending on how far along in the pregnancy you are.

Can there be any complications or risks?

Many women worldwide have undergone this procedure and it has proven to have a very good safety record.

Every form of treatment has some risk or side effect.  With surgical termination, the main risks, though very small are:

  • Excessive vaginal bleeding (this occurs less than 1 out of every 1000 terminations)
  • Failed abortion or ongoing pregnancy (around 2.3 terminations out of every 1000)
  • Infection (in up to 10% of all terminations, but the risk is reduced as you have a sexual health screen and are given antibiotics).

These complications are usually treated very easily.

Uterine perforation (damage to the womb) is rare but can occur in 1-4 per 1000 terminations.  Damage to the cervix can also occur (no more than 1 case per 100 terminations).  Having the procedure performed early in the pregnancy by experienced doctors reduces these risks and the risk of damage to the cervix is minimised with the use of medication that softens and opens the cervix prior to the termination taking place.

In some women, we recommend a tablet to be taken the day before the procedure, to further decrease risks to the neck of the womb.

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 request to see a counsellor at any time leading up to or following the termination, if you are experiencing emotional distress.

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, August 2011).

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 GP if you have any problems following your operation.

Do I have a choice of procedure?

Yes, up to 10 completed weeks of pregnancy there is a choice between general (being asleep) or local (awake) anaesthesia.

Local anaesthetic surgical termination of pregnancy in outpatients

For local anaesthetic we ask that you please arrive on time on the date of your appointment. Please have a light breakfast or lunch depending on when your procedure is to take place.  Please make sure you drink plenty of fluids.

The tablets to prepare the neck of the womb for the procedure (misoprostol) are taken between your cheek and gums, as the nursing staff have explained to you. They must stay there for half an hour to be effective. You will remain awake during the procedure and have a nurse to support you.

Pain relief is provided by a pain relieving tablet approximately one hour before the procedure and a local anaesthetic injection during the procedure.  These will reduce but will not completely remove the cramping feeling as the womb empties during the termination procedure.

The final dose of antibiotic will be given to you to swallow with a hot or cold drink or as a suppository in the clinic before going home, not at the end of the procedure.

The full range of contraceptives will still be available as for other procedures including the four most effective methods; the implant (Nexplanon), the injection, the intra uterine device and the intra uterine system.

Are there any benefits to this type of procedure?

Yes there is, as surgical termination using local anaesthetic techniques permits a faster recovery and return to normal activity.  It avoids the small risk associated with general anaesthesia and reduces the risk of injury to you.

However, this procedure is only available to women who are less than eleven weeks pregnant and is not suitable for those who do not think they can tolerate discomfort or be able to co-operate with the doctor during the procedure.

A local anaesthetic procedure means you can leave the clinic as soon as you feel ready.  You do not have to wait the minimum of two hours before discharge.  However, we do recommend you do not drive yourself home.

General anaesthetic

There are risks associated with general anaesthetic (this is where you are put to sleep for your operation) but these depend on your overall health and your compliance with the ‘no eating and drinking’ rules given.  Risks vary with each patient and you will be assessed to identify your individual level of risk.  If any risk factors are identified, you will be referred to the anaesthetist who will be in charge of your care.  The anaesthetist will then discuss any risks or issues with you.

If you have any concerns at all about having a general anaesthetic, you must let your doctor and nurse know.  We also recommend you read the “Anaesthesia Explained” leaflet that is provided either prior to, or at your outpatient assessment.  It is now sometimes possible to carry out early terminations using local anaesthesia and analgesia, and if this option is appropriate for you, your doctor will discuss this option with you.

Please note: a failure to follow these instructions may result in staff having to cancel or rearrange your operation.

For morning operations

Do not eat anything from midnight.  You can have clear fluids until 6am (alcoholic drinks, fizzy drinks or drinks containing milk are not allowed). You must then remain nil by mouth (nothing to eat or drink).  During this time you must also not chew gum or suck boiled sweets.

For afternoon operations

You may have a light breakfast (cereal or toast) prior to 8am.  You may have clear fluids plain water, black tea or coffee, fruit cordial, but no “fizzy” carbonated drinks) until 10am.  You must then remain nil by mouth (nothing to eat or drink).  During this time you must not chew gum or suck boiled sweets.

Failure to follow this advice will put you at risk of vomiting whilst you are asleep during your operation; this could lead to choking and in some cases this has led to serious consequences.

Guidance for all patients

All patients should ensure they remove all nail varnish, false nails and jewellery (apart from wedding rings, but including all body piercing jewellery) and makeup and if possible have a bath or shower before coming into hospital.

Please bring a dressing gown and slippers with you (for general anaesthetic procedures only).

On arrival onto the ward

The nursing staff will welcome you and show you to your trolley/ bed.  This may be situated in a single room, shared cubicle, or more commonly on the main ward.

Your nurse will help you to get into a theatre gown and will go over your personal details with you (as completed at your last/outpatient consultation) to ensure these remain unchanged. The nurse will check your consent form and check you wish to proceed.

You must let the nurse know if your details have changed since your previous clinic/outpatient appointment.

You will be asked to empty your bladder, but you will not be required to have a shave or an enema.  You will then be seen by a doctor or nurse who will give you tablets.  This starts off the abortion process and must be considered as the point beyond which you cannot change your mind.

Once you are prepared fully for the procedure, your nurse will accompany you to the operating theatre.

Once in the operating theatre

  • If you are undergoing a general anaesthetic procedure you will be put to sleep
  • If you are having a local anaesthetic you will be given medication and pain relief to minimise any discomfort you may experience during the procedure

After the procedure

Once the procedure has been completed and you have undergone a general anaesthetic you will be cared for in a recovery room until you have woken up from the anaesthetic and you have been assessed to ensure your condition is stable following the surgery.  Once stable you will be escorted back to the ward where your nurse will continue to monitor you for approximately two to three hours to ensure you are recovering well, are comfortable and able to tolerate a light diet and fluids.

Discharge advice and information

After the doctors and nurses are satisfied that your condition is stable you will be allowed to go home.  As previously mentioned you must ensure a responsible adult accompanies you home and you have a responsible adult is able to stay with you during your first night at home.

Both general and local anaesthetic can remain in your body for several hours following your operation.  Following an anaesthetic you may feel a little light headed or “cut off”.  You are therefore advised to rest at home the day after your operation.

You are advised:

  • Do not go to work that day or the next day
  • Do not drink any alcohol (beer, wine, spirits)
  • Do not drive or operate any machinery
  • Do not travel on public transport
  • Do not walk through public thoroughfares unaccompanied
  • Take extra care if using domestic appliances at home, especially gas or electric cookers, kitchen utensils, heating systems etc

You may wish to eat but we advise that you do not eat a heavy meal on the evening of your operation.

You should be fit and able to resume your normal activities thereafter.

Blood Loss:

Most women lose bright red blood and some clots from the vagina after the operation.  A few do not bleed at all.  After the first day the blood loss becomes darker and no more clots are passed.  In some women the blood loss comes and goes and in most cases has stopped after 10 days.

You should use sanitary towels only.  Please do not use tampons due to the risk of infection.  Tampons may only be used when you have your next normal period.

Pain Relief:

Most women experience some cramping or lower abdominal pain after the operation.  This normally lasts anywhere between a few hours to a few days.  You are advised to take pain relieving tablets such as paracetamol to relieve the pain as necessary (unless you have an allergy to these or if you have been advised by your doctor not to take these due to existing health problems or medication).  If this is the case, the nurse will advise you on what pain relief medication you are able to take.

Sexual Intercourse:

Do not resume sexual intercourse until after all bleeding has stopped.

When you should consult a doctor

If any the following problems occur following the operation, you should seek medical advice immediately:

  • If the bleeding becomes heavier than normal period
  • If you have severe/generalised abdominal pain (either continuous or “on and off”)
  • If you feel feverish or have a raised temperature
  • If the vaginal loss begins to smell offensive
  • If you feel worried or anxious in any way

Failure to seek medical advice could increase the risk of infection and problems such as pelvic inflammatory disease, which can cause problems with fertility.

Further Information

  1. Your blood will have been tested before your operation.  If you belong to the rhesus negative blood group, you will be given an injection immediately after your operation to prevent the formation of antibodies that might otherwise cause problems in future pregnancies.
  2. You will be given an antibiotic routinely unless you are allergic to it.  This is given orally or as a suppository into your back passage (bottom).  Contraception: It is possible for you to become pregnant straight away following termination of pregnancy and so you must start using contraception immediately.  You may have already decided what contraceptive you would like to use after the termination.  You will have already had the opportunity to discuss contraception with the service at your first visit.  You will be given the opportunity to discuss your needs again  prior to your procedure.
  3. 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, (whilst still asleep if you have had a general anaesthetic).
  4. 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.  Staff are happy to discuss other forms of contraception with you including male and female sterilisation.
  5. For ward admissions,  you should discuss any specific arrangements made with regards to incoming calls with the nurse who admits you.  However, you are responsible for whom you inform about your admission and what you tell them about what you are being admitted for.
  6. 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 before discharge home.

Counsellors:

You can contact the unplanned pregnancy and support service counsellors on telephone number (01482) 844038

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the following departments on the following numbers:

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

Ward 30 (01482) 604387 Women and Children’s Hospital

The Hull and East Riding Sexual and Reproductive Health www.conifersexhealth.co.uk

Family Planning Association www.fpa.org.uk

British pregnancy Advisory Service Tel: 08457 304030 www.bpas.org.uk

Marie Stopes Organisation Tel: 0845 3008090 www.mariestopes.org.uk

Royal College of Obstetricians and Gynaecologist www.rcog.org.uk

Follow-up

We recommend you have a routine checkup in approximately four to six weeks. This is to ensure you are recovering physically and emotionally from the 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 Pregnancy Advisory Clinic at the Women and Children’s Hospital, Hull Royal Infirmary.

If you would prefer to have your check up at the Pregnancy Advisory  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 telephoning (01482) 607837 and saying you need a DC4 appointment. This will ensure you are given an appointment within the next week.

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 Baby 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.

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.