Important Changes to Medical Abortion Procedures
From August 2009
- Medical abortion procedure now done up to 9 weeks (63 days)
- Patients who are 7 weeks pregnant or less (49 days) can choose to go home after medication has been administered on day 2.
Medical Abortion
The medical abortion procedure uses tablets instead of surgery to interrupt and expel an early pregnancy. Treatment requires two separate visits. During the first visit, one Mifepristone tablet containing 200mg of Mifepristone is taken. This tablet has a blocking effect on progesterone, a hormone that is needed for pregnancy to continue.
At the second visit, 24 hours later four tablets, each containing 200μg of Misoprostol are administered. This is a different type of hormone (a prostaglandin), which helps to expel the pregnancy. In some cases, the doctor may change the doses of both drugs. A full written explanation on these medicines will be provided at AMAC.
Who can use the treatment?
Most women can use it, however, AMAC will not provide the treatment if:
- You are unsure about your decision to have an abortion because once you have taken either medicine there is a risk that if the pregnancy continues, the baby may be born with abnormalities. Discuss the difficulties in making a decision with your doctor, nurse or counsellor.
- You have an ectopic pregnancy (where the fertilised egg is implanted in the tube rather than in the womb).
- The scan reports the pregnancy as being more than 55 days ago.
- You have ever had a bad reaction to Mifepristone or Misoprostol.
- You have an IUCD in place (Must be removed before taking Mifepristone).
- Your haemoglobin is less than 100.
In some other circumstances the treatment may also be unsuitable, so tell your doctor if:
- You are a smoker aged more than 35 years
- You have a medical condition such as a heart complaint, high blood pressure or diabetes.
- You suffer from severe asthma or are on long-term steroid treatment.
- If you are anaemic, have a bleeding disorder or are receiving anticoagulants.
- You have had an operation on your uterus (womb).
Some other precautions
The treatment is not suitable if you do not have a telephone or are living more than one hours travelling time from emergency hospital services. This is in case of heavy bleeding needing emergency treatment.
If you are breast-feeding you should stop for at least 14 days after taking Mifepristone.
You should not drink alcohol or smoke once you have taken the Mifepristone and for at least two days after you have been given the tablets. You should not take illicit drugs.
Some medicines may interfere with the treatment. These include some pain relief and anti-inflammatory tablets such as Aspirin, which should not be taken from the time that you take Mifepristone until the time of your check up. If you take other medicines tell the doctor
How is the treatment taken?
You will be given one tablet of Mifepristone orally. You must take this at AMAC. You will be discharged about half an hour after taking the tablet.
Have a good supply of maxi-pads for use at home.
If you have any concerns, such as heavy bleeding, you must ring AMAC for advice. In a few cases (3-5%) the abortion may occur after Mifepristone alone.
You will be given an appointment to return to AMAC the next morning, when the tablets are administered. After this we prefer you stay at AMAC until the doctor is satisfied that the abortion is complete and you are well. You will be discharged home with written instructions on self and emergency care.
If you have not passed the pregnancy after 6 hours, the doctor will discuss the options with you. It may be recommended that you have a surgical operation before you are discharged home. If you choose to go home without surgery it is vital that you return to AMAC in one weeks time to make sure the abortion is complete, bleeding and cramping are not proof that the abortion is complete. You will be contacted if you fail to attend.
If you have a rhesus negative blood type, an injection called Anti D will be offered to you to protect against antibodies forming in the blood, which may cause problems in a future pregnancy.
You will be required to make an appointment with your referring doctor in 10-14 days to make sure you have made a full recovery.
What are the effects of the treatment?
After taking the Mifepristone tablet, usually nothing much will happen for about 12 hours. Occasionally women may feel unwell, perhaps a little faint or sick during the first few hours.
About half of the women who take Mifepristone will start to bleed before returning to have the tablets administered. The bleeding can be heavy, like a heavy period. You may also get cramps like period pains.
After being given the tablets, if you are not already bleeding, you will bleed and it is likely that you will get abdominal pain and cramps which may be quite strong. A medical abortion is like having a miscarriage. In some cases the bleeding can be heavy and in a small number of cases (about 1 in 300), it may be necessary to give a blood transfusion and /or perform a surgical abortion to stop the bleeding.
Painkillers such are prescribed if required. Pain can be worse in women who have never been pregnant before or in women who normally suffer painful periods.
A few women have diarrhoea, sickness, headaches, dizziness, hot flushes, chills or a rash after being given the tablets. Please report any side effects, to the medical staff.
In over 90% of cases, the pregnancy will be expelled in the 6 hours after the tablets are administered. If the medical treatment fails to end the pregnancy, a surgical abortion will be necessary.
(Comprehensive written information on possible side effect will be provided and discussed at your appointment).
Many women ask if they will be able to see the embryo. The sac and placenta surrounding the embryo can usually be seen; the embryo is very small but often visible (approx 3mm) depending on how pregnant you are.
What about contraception?
It is possible for you to become pregnant again immediately after the abortion, so you will need to start contraception such as oral contraceptives within 3-9 days of taking the Mifepristone. Discuss this further at AMAC or with your doctor. You will be advised not to have sex for 14 days after the abortion is complete.
What to expect after you go home
You will be advised not to put anything into the vagina for 14 days i.e. no tampons, no vaginal intercourse, bathing or swimming.
A small number of women may develop an infection. This may cause a temperature, pain, discharge or unusual bleeding. Contact AMAC if you have any concerns.
You may continue to bleed for several weeks. If the bleeding is heavy (more than two maxi-pads in an hour for two hours) you should contact AMAC, your referring doctor or emergency hospital medical services.
You should recover fairly quickly from your abortion, but take things easy for a few days. Further counselling is available if you feel it would be helpful.
(Comprehensive written aftercare instructions will be provided at AMAC)