The Lilac Clinic

Your first appointment will be a telephone consultation. You will first speak to a nurse who will ask questions about your medical and obstetric history, you will also be asked the reason why you want the termination. You will have a discussion about the treatment options available. They will also discuss contraception.

You will be booked for a scan when you are approximately 6 weeks. Scanning before this means we may not be able to see the pregnancy yet as it will be too small. This scan is usually performed trans-vaginally which means the probe will be inserted into your vagina. During the scan the screen will be turned away unless you ask to see it. Following scan you will see the nurse and doctor who will confirm your decision and treatment options and obtain your consent for the termination of pregnancy. If you are having an early medical abortion we are often able to give you the tablets at this appointment. For later medical abortions or surgical abortions, you will need to return at a later date for your treatment.

We recommend chlamydia screening to all women and offer you a swab to be done by yourself. We are unable to provide this service through clinic at the current time.  You can  also access this through ‘Locala’ who provide free self- test kits through the post. You can access this service on line or by telephone 03033309500.

Medical termination

A medical termination of pregnancy can be performed up to 9 weeks and 6 days of pregnancy as an out- patient (at home) or up to 12 weeks and 6 days as an in-patient (in hospital).

It is called a medical termination because it uses tablets to cause the termination rather than an operation or a procedure. It is essential that you are sure you wish to proceed with the termination before you take any medication. If you have any questions or concerns, please discuss these with a member of the nursing team.

What happens with a medical termination?

This appointment will be in the Women’s Health Unit. Please expect to be here about 30 minutes.

We will give you a Mifepristone tablet to take orally (swallow) in clinic so we advise that you have something light to eat before your appointment. These tablets block the action of the natural hormone progesterone. Progesterone is produced by a woman in increasing amounts in the early stages of pregnancy; it is needed to keep the pregnancy attached to the lining of the womb.

When you take Mifepristone (the first medication you will be given) it blocks the progesterone. The Mifepristone also has an effect on the cervix causing it to start to open and works on the muscular wall of the womb making it likely to contract. Please note continuing with a pregnancy following taking Mifepristone means that there is an increased risk of miscarriage and a 2-3% increase in your risk of having a baby with abnormalities.

If you vomit within two hours of taking the tablet it is essential that you phone the Women’s Health Unit (contact number below) as vomiting can make the tablet ineffective.

Things to avoid

• You should not eat grapefruit or drink grapefruit juice as it may affect the absorption of the Mifepristone.
• If you need any pain relief take Paracetamol as directed. Avoid taking Ibuprofen tablets until the next day as these can affect the absorption of Mifepristone.

Possible side effects of Mifepristone
Side effects are rare and you can continue your normal activities as planned. Some women will however experience some side effects from Mifepristone which can include nausea/ vomiting/skin rash/feeling faint and rarely collapse.

You may start with stomach cramps and bleeding. Even if you do start bleeding it is still essential that you continue to take the Misoprostol that you have been given to take at home to ensure the termination process completes.

Breastfeeding:
If you are breastfeeding at the time of your abortion, please be aware that mifepristone may pass into the breast milk in very small quantities. Studies so far do not show that this causes any problems for the baby. However, if you want to be cautious you can avoid breastfeeding for 24 hours after taking the abortion pill. (levels are highest between 6 and 9 hours after taking the tablet) We would advise you continue to express your breastmilk and discard it to ensure you continue with the production. There are no adverse effects on the baby from misoprostol.

Misoprostol
Misoprostol softens the neck of the womb (cervix) to allow the pregnancy to pass. You will take four tablets sublingually (dissolve under your tongue) at home or in the clinic. If you are taking the tablets at home, the nurse will give you the ‘Instructions for outpatient termination of pregnancy leaflet’ which will advise you at what time you should take those tablets to ensure that they have the best chance of working.

• You may experience sickness, diarrhoea, a fever and shivering as a result of this medication.
•  You will start to cramp and bleed approximately 1 to 4 hours after taking misoprostol tablets. Most women pass the pregnancy within 4 to 6 hours of taking the second medicine. You should have someone to assist you if your symptoms are severe. Some women may have lighter bleeding for several days, then pass clots and the pregnancy.
• Do not use tampons
• You can eat and drink normally
• It is normal for a termination to cause pain. To help with the pain take the pain killers you have been provided with. You can also take ibuprofen, which you can buy over the counter

After care

It is essential that you remember that you will be at risk of getting pregnant again immediately following the termination. Therefore you must use reliable contraception.

We do advise that you do not have sexual intercourse for two weeks following the termination to reduce the risk of infection.

You can expect to bleed for up to two to three weeks after the termination is completed. Contraception choices and advice will be discussed at your appointment and can often be provided on the day.

Possible complications associated with medical termination of pregnancy

• Very heavy bleeding : Haemorrhage occurs in 1 in 100 terminations; however the earlier the termination is done this lessens the risk.
• There is a small risk of infection following the procedure. This may show as an offensive/smelly vaginal discharge associated with on-going pain – you may need a course of antibiotics for this.
• 1 in 100 medical terminations will fail to end the pregnancy – it is essential to contact us if you do not bleed after the tablets and check your pregnancy test as advised usually 3 weeks after treatment. Contact us if the pregnancy test is still positive.
• In 1 in 100 medical terminations the uterus is not completely emptied and you may require extra treatment.

A letter will be sent to your Doctor or whoever referred you to inform them of the termination of pregnancy. However, if you do not wish for that to happen, inform the nurses and we will not send the letter.

Surgical (suction) termination of pregnancy

A surgical termination involves suction to remove the pregnancy. Surgical termination is done between eight and 12 weeks and six days and normally involves a general anaesthetic. However, we are currently doing the procedure under local anaesthetic, as an outpatient, due to risks of general anaesthetic associated with COVID-19. This procedure is called a MVA (manual vacuum aspiration) and means you will be awake during the procedure. You will have misoprostol inserted under your tongue before you have the procedure to help soften the cervix before the procedure. You are usually expected to be at the hospital for up to three hours.

These procedures require admission to ward M2 in the Woman’s and Newborn Unit.

Possible complications of having a surgical (suction) termination of pregnancy

• Anaesthetic complications
• Bleeding- if very heavy blood transfusion may be required
• Damage to the cervix, perforation of the uterus
• Retained products of conception
• Pelvic infection
• Very small risk of the pregnancy continuing
• Death

The Lilac Clinic also offers a 24-hour, seven days a week follow-up service.