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Safe Termination Of Pregnancy-Information For You

Termination services are confidential and any information disclosed during your visit will not be shared unnecessarily.

What is a medical termination?

A medical termination is where you take a medicine which will end the pregnancy. The medical name for the medicine is mifepristone. It works by blocking the hormone progesterone. Without progesterone, the lining of the uterus breaks down and the pregnancy cannot continue.

Why do I need a medical termination?

You have opted to have a medical termination to end your pregnancy.

Can there be any complications or risks?

Many women worldwide have used this treatment and it has proven to have a very good safety record. Every form of medical treatment has some risk or side effect. With this treatment the main risks, though small are:

  • Excessive vaginal bleeding, such that you may need a blood transfusion, happens in around 1 in every 1000 abortions.
  • Infection (4-10%)
  • Retained products and need for surgical evacuation (in about 3-5%)
  • Prolonged bleeding
  • Emotional upset

Treatment including surgery may be required if complications occur.

Are there risks after the abortion?

You are more likely to get problems in the 2 weeks after the termination of pregnancy than at the time of the procedure itself:

Up to 1 in 10 women will get an infection after a termination of pregnancy. Taking antibiotics at the time of the abortion helps to reduce this risk. If you are not treated, it can lead to a more severe infection known as pelvic inflammatory disease (PID).

The uterus may not be completely emptied of its contents and further treatment may be needed. This happens in fewer than 6 in 100 women having a medical termination and in 1 to 2 in 100 women having a surgical termination. An operation may be needed to remove the pregnancy tissue within the uterus.

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 a counsellor leading up to and following your termination, if you feel you require emotional support.

The risks of developing 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.

What are the risks of the termination of pregnancy failing?

All methods of early termination of pregnancy carry a small risk of failure to end the pregnancy and therefore a need to have another procedure. This is uncommon, occurring in less than 1 in 100 women.

How do I prepare for the medical termination?

Please read the information leaflet. Share the information it contains with your partner and family (if you wish) so that they can be of help and support. There may be information they need to know, especially if they are taking care of you following this procedure. You will be offered information and support if you decide not to have a termination.  You have the right to delay or cancel appointments. You can also change your mind about having a termination at any stage and inform your consultant.

You have to be prepared to go through with the full termination procedure once mifepristone is swallowed. This is because of the risks the drugs may have to the developing fetus, causing abnormalities, if the pregnancy continues.

What will happen?

Following the first consultation, you will be asked to get some blood tests done which include Haemoglobin, Blood grouping, Thyroid tests and Infection screen and other test if relevant.

The medical termination of pregnancy takes place in 2 steps (24 or 48 hours apart).

Visit 1

You may have breakfast before you come in. Your blood tests will be reviewed and you will be asked to sign a few forms as consent to the procedure, which are important and will be maintained confidentially. You will be given a mifepristone tablet to swallow with some water – this is the point beyond which you cannot change your mind.

Sometimes the mifepristone tablet can make you feel sick, and so we ask you to stay in the department for half an hour after taking the tablet. You will be told when to come back to the department for your second visit.

You may start to bleed and have a period type pain prior to attending the hospital for the second part of the procedure. There is a small chance that you could expel the pregnancy at this stage, although this is not very likely. This may be like a heavy period. Please do not use tampons if you start to bleed.

You are advised to take medication such as ibuprofen or paracetamol to relieve any pain you get. Only take those recommended by staff until two days after all bleeding has stopped. You must also avoid alcohol and smoking until treatment is complete.

Visit 2

The second visit will involve a day care admission. For the privacy and comfort of you and other patients we request that you be accompanied by only one adult during your second visit. Please do not bring children with you.

On admission, you will be asked about any pain or bleeding you may have had over the last two days. If you have had any symptoms please inform the staff now. If all is well the procedure will continue.

To encourage the womb to contract and expel the pregnancy, you will be given  some tablets (misoprostol) vaginally, Soon after this, you may begin to experience a period type pain and some vaginal bleeding. A nurse will be available throughout your stay and will provide you with painkillers if you need them. The nurse will also provide support and companionship. If your blood pressure drops or you have vomiting, you will be given some IV infusions and medications though an IV cannula.

The medications are repeated up to three times orally.

Uncommonly, you may experience diarrhoea, sickness, headache, dizziness and hot flushes/chills. Let your nurse know straight away and she will help you to cope with these symptoms. There is no need to be worried about these.

You will have to stay in the hospital for up to 6-10 hours following the tablets. During your stay, you do not have to go to bed and will be able to move around as you wish. You will be asked to use a receiver/bed pan every time you use the toilet, so the nurse/doctor can assess if the abortion has taken place. You may take some light soft diet during your stay on the discretion of your doctor.

However if the procedure is not complete, you may be given a repeat dose of the tablets the next day.

Very rarely (only one case in every 300) the pregnancy will continue. If you have a rhesus negative blood group, you will be given an injection immediately after your procedure to prevent the formation of antibodies that might otherwise cause problems in future pregnancies.

  • You will be given 2 antibioticsroutinely unless you are allergic to them. You will be asked to take one of them for 7 days.
  • Contraception: It is possible for you to become pregnant straight away following termination of pregnancy, so you must start using contraception straight away. You may have already decided what contraceptive you would like to use after the termination.  Your consultant will discuss the options during your first and second visit.
  • If you wish to have an intra-uterine device or system (‘coil’)fitted or the implant, this can be done immediately or after your check scan.
  • Sexual Health:You may be at risk of getting a sexually transmitted infection if you do not practice safe sex and use condoms.
  • Counselling: You may request for a counsellor to see during your stay.

At the end of the procedure the nurse will check that you are well enough to go home. You can eat and drink normally. If you have experienced heavy bleeding or persistent pain we may advise you to stay in hospital overnight, until any problems are resolved. This should be borne in mind as regards to making family arrangements.

A responsible adult who knows what procedure you have had should accompany you home and stay with you overnight.

Follow up and discharge advice

You will be asked to come back in 1-2 weeks for a review of symptoms and a check scan to confirm if the uterus is completely empty.

You may continue to bleed for at least two weeks following the termination. You may also require mild painkillers (such as ibuprofen or paracetamol). Please do not use tampons until your next period. Do not resume sexual intercourse until all bleeding has stopped.

NB – If you feel ‘fluey’, develop an offensive discharge, persistent and increasing tummy or generalised pain, a high temperature or fever, or any increase in bleeding, you will need to come to the hospital.

Dr. Aruna Muralidhar,
Senior Consultant O&G,
Fortis La Femme Hospital,
Bangalore.

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