A medical termination of pregnancy can be performed up to nine weeks and 6 days of pregnancy.
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 (under your tongue) 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 and the pregnancy detaches itself from the womb lining. 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.
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 softens the neck of the womb (cervix) to allow the pregnancy to pass. You will take four tablets sublingually 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
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 or an offensive/smelly vaginal discharge.
- Haemorrhage occurs in 1 in 100 terminations; however the earlier the termination is done this lessens the risk.
- 1 in 100 medical terminations will fail to end the pregnancy
- In 1 in 100 medical terminations the uterus is not completely emptied and you may require extra treatment.
- There is a small risk of infection following the procedure. You may need antibiotics to resolve this.
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
Surgical termination is done between 8 and 12 weeks and 6 days and normally involves a general anaesthetic. However, we are currently doing the procedure under a spinal anaesthetic due to concerns regarding coronavirus. A spinal anaesthetic is similar to an epidural and means you will be awake during the procedure. You are usually expected to be at the hospital for up to 6 hours.
These procedures require admission to ward 5 in Bradford Royal Infirmary. You will have misoprostol inserted into your vagina or under your tongue before you go to theatre to help soften the cervix, the doctor in the lilac service will let you know if this will be required. A surgical termination involves suction to remove the pregnancy.
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