Having a medical abortion when you are up to 10 weeks pregnant

An outpatient medical abortion is a procedure which ends pregnancy and can be done up to 10 weeks gestation (10 weeks along in the pregnancy).

It is a two step process involving taking different medications. There is no surgery involved in this, and you are awake. 

After your first telephone consultation, you can attend the clinic for assessment. If you would like to have this procedure at home, your healthcare professionals will let you know if this is possible. It may be that this can be started on the same day or at a time that suits you. 

The first medication is called Mifepristone. You will then have a different medication to take 48 hours later called Misoprostol.

Mifepristone, the first medication, blocks the action of progesterone, a hormone that is essential to a developing pregnancy.

Misoprostol, the second medication, softens your cervix (neck of the womb) and causes your uterus to contract.

This method of treatment may not be right for some people. Please let medical staff know if you have any medical conditions or if you take any regular medication.

There are some risks of having an outpatient medical abortion, these include:

• some pregnancy tissue still remaining (up to 5 in every 100 terminations), which may need further treatment
• the procedure not working (less than 1 in 100 procedures), which means that your pregnancy continues
• excessive bleeding needing transfusion (less than 1 in 1,000 procedures)
   

You will have an ultrasound scan to confirm the location of the pregnancy and gestation (how many weeks pregnant). You will also be offered sexually transmitted infection tests and have routine observations performed such as your blood pressure, height and weight.

You will be given a pack to take home with you which will include:

• medications
• a urine pregnancy test
• your chosen contraception (if applicable)
• relevant information

How to take the medication

We advise that you always have someone over the age of 18 with you during the procedure to help you in getting medical attention should you need it.

Day 1

The first tablet (Mifepristone) should be swallowed with some water. This medication can make you feel sick or make you vomit (be sick). If you vomit within half hour of taking this medication you will need to contact the Pregnancy Advisory Service as you will need to take another dose. 

You can have light vaginal bleeding and abdominal (tummy) pain after taking the first tablet. Please only use sanitary towels, and avoid using tampons or menstrual cups. If the bleeding is heavy and / or you feel you pass the pregnancy before taking the second stage of tablets (Misoprostol) please get in touch with:

• Pregnancy Advisory Service on 01709 424542
• Ward B11 on 01709 424542

Day 3 (two days after taking your first stage of medication)

Place all four of the misoprostol tablets either:

• high up in your vagina 

or 

• swallow the tablets orally with water

or

• place between your teeth and gum and allow to dissolve for 30 minutes. 

If the tablets have not completely dissolved within 30 minutes, you may swallow what is left with water.

Vaginal insertion

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Insert the four tablets as high as possible in your vagina. The exact location is not important, only that they do not fall out. 

You can do this while lying down, squatting or standing with one leg up - whatever is most comfortable for you.

Positioning the tablets in your mouth

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Some people describe the taste of misoprostol as unpleasant and the texture as chalky. 

Placing the tablets between the cheek and gum can make you more likely to have nausea (feeling sick), vomiting (being sick) and diarrhoea (liquid poo).

Day 4 - Contraception

You should make sure you use contraception from the day after you have taken misoprostol.

Bleeding and cramping normally starts two to four hours after taking the misoprostol. You may see other tissue and, the further on in your pregnancy, the more recognisable it may be to see an identifiable foetus (pregnancy). 

It is likely you will experience strong cramping pains during the procedure. Pain can be helped with:
•    pain relief, such as paracetamol, ibuprofen and codeine phosphate
•    a comfortable environment
•    comfortable clothes

If the pain is severe and / or you feel unwell, dizzy or develop shoulder tip pain or if you have heavy vaginal bleeding you should attend your nearest Urgent and Emergency Care Centre / Accident and Emergency or call 999.

Once you have passed the pregnancy, we would expect your vaginal bleeding and pain to settle over about 10 to 14 days.

You should wear a sanitary pad to monitor your bleeding during the procedure. Do not use tampons or menstrual cups. The amount of vaginal bleeding can vary from person to person. 

If you have persistent heavy vaginal bleeding (soaking two maxi sanitary pads within an hour or pass blood clots larger than a 50p coin) and/or start to feel unwell you must attend your nearest Urgent and Emergency Care Centre / Accident and Emergency or call 999.

It is also not normal to have no or only a small amount of vaginal bleeding.

If you do not bleed or have very little vaginal bleeding for 24 hours after taking misoprostol it is important you contact the Pregnancy Advisory Service or ward B11.

We will ask you to do a urine pregnancy test three weeks after your procedure. This is to ensure the procedure has worked and that you are not pregnant. Instructions on how to perform and interpret the pregnancy test are included in the pack that you take home. If your pregnancy test is still positive, you need to tell the Pregnancy Advisory Service so that you can have another appointment.

It may be that you pass the pregnancy when you use the toilet. If this does happen we do not expect you to retrieve any pregnancy tissue from the toilet, you may flush the toilet as usual. If you feel unable to flush the toilet or the pregnancy passes and you have the remains, please contact the Pregnancy Advisory Service. 

Please note, there are laws around personal burial of pregnancy remains.

If an inpatient procedure has been recommended to you, or you have chosen to have your treatment in hospital then you will be given the first tablet (Mifepristone) at a clinic appointment. You will need to return 48 hours later for the second stage of treatment (Misoprostol).

When you return, you will be asked about any pain or bleeding that you may have had. If you have had any other symptoms, please inform the nurse. 

Bring any prescribed medicine or inhalers with you for this visit. You should also bring an overnight bag with you in case you need to stay overnight.

You can bring someone to stay with you at this visit. However there are no facilities for children; you will need to make alternative arrangements for childcare. Please let staff know if you have any problems with this. We advise for you to have an adult to escort you home after the procedure.

You will be in a private room where the second medication (Misoprostol) will be administered. 

Once the nurse has checked your details, they will start your treatment by inserting four Misoprostol tablets into your vagina.

These tablets will make your womb contract and your cervix open. This will help your body to pass the pregnancy tissue. You will be advised to rest in bed for one hour after administration of the vaginal Misoprostol. After the first hour you will be encouraged to walk around as much as you are able. At this stage, bleeding will begin and it is likely to be heavier than a normal period. You will also start to have period like pains, and we can offer you a range of prescribed painkillers to help with this.

You may have the following side effects:

• nausea (feeling sick)
• vomiting (being sick)
• vaginal bleeding with strong abdominal (tummy) cramping pain
• diarrhoea (liquid poo)
• headache
• dizziness
• hot flushes / sweating.

You must use a bedpan every time you go to the toilet so that the nurse can check your bleeding or to see if you have passed the pregnancy. 

If you are uncomfortable going to the toilet alone, please ask the nurse who will accompany you. During your stay, you may eat and drink as normal.

If you have not passed the pregnancy within three hours, you will be given a further dose of two Misoprostol tablets. 

The nursing staff may ask to examine your vagina if:

• there is not much progress 
• if the staff are unsure if everything has passed
• if there is a lot of bleeding 

however, an examination is not essential before you go home. 

If the pregnancy has not passed after both doses of Misoprostol and you are feeling well and have minimal bleeding, you may be discharged with a rescan in one weeks’ time.

All tissue from a termination of pregnancy is disposed of in a sensitive way. If you wish to discuss this further, please ask a member of staff.

How soon after Misoprostol can I go home? 

The whole process usually takes 6 to 8 hours however, it may sometimes vary. 

You may have to stay overnight if there is excessive bleeding or if you are feeling unwell.

How long will I bleed for?

Bleeding up to three weeks following the termination is normal. Some people bleed for less time, while others may bleed until their next period. If bleeding continues beyond three weeks, or it becomes heavy, please contact Pregnancy Advisory Service. 

You should not use tampons or menstrual cups until the bleeding has stopped. This helps prevent the risk of infection.

When to be concerned

• Bleeding not settling after three weeks or passing a large palm-size clot
• Intensifying pain
• Fever
• Bad smelling vaginal discharge 
• Feeling generally unwell.

Contact Pregnancy Advisory Service or see your GP.

You should not have sex until you have stopped bleeding.

It is possible to become pregnant again 5 days after this procedure, so it is important to start your contraception immediately. We will discuss contraception options with you before you go home.
 

People can experience a wide range of emotions following a termination of pregnancy. Making a decision like this can be very difficult. Counselling is available for you and your partner, please contact Pregnancy Advisory Service if you wish to be referred.

Abortion Talk also offer support surrounding termination of pregnancy and can be accessed via www.abortiontalk.com or by calling them on 0333 090 9266.
 

Please refer to the aftercare information.

Contact the Pregnancy Advisory Service if you:

• have any concerns
• change your mind about having treatment
• are sick within half an hour of taking Mifepristone (Day 1 medication)
• think you have passed the pregnancy without taking the second stage of tablets
• have severe side effects such as diarrhoea or vomiting
• have not had any vaginal bleeding or only had spotting
• still feel pregnant and your pregnancy test is still positive after three weeks
• still feel pregnant and your period has not resumed four weeks after the abortion – do a pregnancy test and contact the Pregnancy Advisory Service
   

Attend the Urgent and Emergency Care Centre (UECC) or nearest Accident and Emergency if you:

• have a concern that you feel is urgent
• have heavy vaginal bleeding which soaks a sanitary pad within 30 minutes
• keep passing blood clots larger than a 50p coin
• have pain in your tummy, shoulders, feel dizzy and unwell – attend UECC immediately
• have any symptoms of an allergic reaction from the medication, such as difficulty breathing – call 999 immediately
   

Pregnancy Advisory Service 

Telephone 01709 424542 
Monday to Thursday, 8am to 6pm  

Early Pregnancy Advisory Unit 

01709 427072
Monday to Friday, 8am to 4pm. Closed on Bank Holidays.

Ward B11

01709 424349 
Please contact on weekends, Bank Holidays or 4pm to 8am.