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Here, we answer some frequently asked questions about terminations.
This includes some discussion about the risks and advantages of
one method compared with another. These can seem alarming but many
thousands of women have had both methods worldwide and they are
both considered very safe procedures. Either method is considerably
safer than continuing the pregnancy to term, which is the alternative.
Why do I need to decide early in my pregnancy that I need a
termination?
It is considerably safer for you to terminate a pregnancy before
12 weeks of your pregnancy than later in the pregnancy. This is
why it is important to visit someone who can refer you to a termination
clinic as soon as possible. Your general practitioner (GP) or
a family planning clinic can refer you.
How do you decide which method to use?
The method we use to terminate your pregnancy depends on your
preference and to some extent on how many weeks pregnant you are.
How can you tell how many weeks pregnant I am?
In the UK, it is traditional to 'date' your pregnancy from the
first day of your last period. This is usually about two weeks
before the sexual intercourse that led to your pregnancy. Therefore
if you are told you are nine weeks pregnant it means you actually
got pregnant about seven weeks ago. We can either work out how
many weeks' pregnant you are from your last period or by using
an ultrasound scan (eg if you have irregular periods).
What is an early medical abortion (EMA)?
An early medical abortion is the method that can be used earliest
in pregnancy. You may have one from as soon as the pregnancy is
confirmed up to nine weeks of your pregnancy. It is called a medical
abortion because it uses tablets to cause the abortion rather
than an operation.
What does an early medical abortion involve?
An early medical abortion is a two-stage procedure. For legal
reasons, both stages have to take place at a designated hospital
or clinic.
1. In the first stage, you come to the clinic to swallow a tablet
(called mifepristone).
2. For the second part you need to return to the hospital between
one and three days later. A nurse will place some tablets (called
prostaglandins) high up in your vagina (you can do this yourself
if you prefer). This triggers the miscarriage of the pregnancy,
which will usually happen between one and six hours later (while
you are at the hospital).
How does the medical abortion work?
The first mifepristone tablet blocks the action of the natural
hormone progesterone. Progesterone is produced by a woman's body
in increasing amounts in early pregnancy, and is necessary to
keep the pregnancy attached to the lining of the uterus (womb).
When the mifepristone prevents the progesterone from doing this,
the pregnancy detaches from the womb and dies. The mifepristone
also has some effect on the cervix (neck of the womb), causing
it to start to open, and on the muscular wall of the uterus, making
it more likely to contract. The second tablets (prostaglandins)
cause the uterus to contract (like period cramps) and so expel
the pregnancy.
Why is the early medical abortion safer than a surgical one?
The early medical abortion is safer for you than a surgical termination.
This is because you don't need to have a general anaesthetic and
no instruments need to go into the womb. It, therefore, has a
reduced risk of both infection and of physical damage to the cervix
or womb.
Are there any disadvantages of choosing an early medical abortion
compared with a surgical one?
There are some disadvantages to having an early medical abortion
including:
-
It is a more drawn-out procedure than a surgical termination,
taking place over several days. You have to make two visits
to the hospital, the first to take the mifepristone tablet
and the second for the prostaglandin treatment. For the second
visit, you will be at the hospital for several hours
-
During the second visit, after the prostaglandin treatment,
you will experience some pain, which is like a strong period
pain. We can give you some pain-killers to relieve this. You
might also experience other side effects of the prostaglandins
such as nausea, diarrhoea and hot flushes. These are temporary
and we can give you some medication to help.
Who is the early medical abortion method most suitable for?
We will recommend the medical method to you if you:
-
Are in the first few weeks of your pregnancy and would need
to wait some time to have a surgical termination.
-
Are already having unpleasant symptoms of early pregnancy
(usually sickness).
-
Don't want to have a general anaesthetic for a surgical termination.
-
Because of medical problems or being very overweight, are
at greater risk than normal from a general anaesthetic.
-
Feel this method allows you to keep more 'control' of your
body - some people regard it as more 'natural' than a surgical
termination.
When can a surgical termination of pregnancy (STOP) be used?
A surgical termination of pregnancy can also be called a vacuum
termination of pregnancy (VTOP) or suction termination of pregnancy.
Although it is called a surgical termination (it is performed
by a surgeon) the operation does not involve any 'cutting'. It
can be used between 8 and 12 weeks of pregnancy, and sometimes
a bit later.
What does a surgical termination involve?
For a surgical termination, you need to have a general anaesthetic.
While you are 'asleep', the cervix is first gently stretched and
then a small instrument is passed through the cervix into the
uterus. This removes the pregnancy by gentle suction. The whole
procedure takes about ten minutes.
Do I need to stay in hospital overnight for a surgical termination?
At Addenbrooke's, surgical terminations are usually carried out
at the Day Surgery Unit
- you come to the hospital early in the morning and are ready
to go home at lunch-time. Because you will have a general anaesthetic,
you will feel drowsy for some hours afterwards. Therefore, you
must have a responsible adult to take you home afterwards and
to look after you when you get home. If you have medical problems,
you might need to stay overnight before and/or after the procedure
- this will be explained to you.
Who is the surgical termination method most suitable for?
You might have a surgical termination rather than a medical one
if:
-
Your pregnancy is too advanced to have an early medical abortion
(after nine weeks).
-
You prefer not to go through the two-stage procedure - you
would rather 'go to sleep', and know the termination is over
by the time you wake up again. Some people find it difficult
to make two visits to the hospital.
-
You don't want to experience the temporary side effects of
the prostaglandin part of the medical termination.
What are the disadvantages of having a surgical termination
compared with a medical one?
Everything we do in life carries some risk. The extra risks involved
with a surgical termination relate to the general anaesthetic
and to the procedure itself. For medical reasons, these risks
are greater for some women. This will be explained to you.
-
Because instruments need to be placed into the womb itself,
there is a higher risk of infection than with an early medical
termination.
-
Rarely, the instruments can cause damage to the cervix or
the uterus itself, which might mean that you need further
surgery to repair the damage. Very rarely this may affect
your future fertility.
What can go wrong with either type of termination?
Doctors call things that are known to go wrong with a treatment
or test a complication. The complications that can happen with
either method of termination include:
-
Your pregnancy might not be terminated. This is very rare
but it can happen. If the termination has worked, you should
have a period about four weeks afterwards. If you don't, or
if you continue to 'feel pregnant', then you must do a pregnancy
test. Pregnancy tests can stay positive up to three weeks
after a termination, but should be negative by four weeks.
If the termination fails, you might have to return for another
termination procedure.
-
The termination might be 'incomplete'. This means that some
tissue has remained in your womb. This can cause you to continue
to bleed heavily, or you can develop signs of infection in
the womb. If this happens, you might have to have a small
operation to complete the process. This operation is called
an evacuation of retained products of conception (ERPOC),
which is the same operation that some women who have a spontaneous
miscarriage need.
-
You might have excessive bleeding. Some bleeding from the
vagina is a normal part of either procedure and can continue
for 10 to 14 days. This bleeding is usually heavier with an
early medical termination. Rarely, women bleed much more heavily,
either at the time of the termination or later. If this happens,
you might require a blood transfusion.
I want a termination but my pregnancy is already over 12 weeks.
If you are just a little over 12 weeks pregnant, you might be
able to have a surgical termination but you might be admitted
to hospital overnight because of the greater risk of complications
- these are mainly excessive bleeding. If you are over 14 weeks
of pregnancy, it is necessary to have a later medical termination
(see below).
What is a mid-trimester medical abortion (or later medical abortion)?
If you are more than 14 weeks pregnant and need to have a termination,
we would recommend a mid-trimester medical abortion. Trimester
means 'three months' so a mid-trimester is the middle three months
of pregnancy.
What does a mid-trimester medical abortion involve?
A mid-trimester medical abortion uses the same medications as
an early medical abortion (see above) but the aim of the treatment
is to induce a 'mini-labour'. You will swallow a mifepristone
tablet at your first visit and then come back to the hospital
one to two days later. At this second visit, you will have a first
dose of prostaglandin high in your vagina and then one to four
more doses by mouth until the pregnancy is lost. This takes longer
and can causes more pain than in an early medical abortion. We
can give you some strong pain killers to help you, and other medications
for other temporary side effects of the prostaglandin treatment
(sickness etc - see above).
How does a mid-trimester medical abortion work?
If you are more than 14 weeks pregnant, the mifepristone tablet
doesn't end your pregnancy - it just sensitises your womb to the
effects of the second tablets (prostaglandin), which are given
one or two days later. Because the pregnancy is much bigger than
with an early medical abortion, the cervix needs to dilate further
to allow the pregnancy to be expelled.
Will I need to stay overnight after a mid-trimester medical
abortion?
Most people who have this procedure are able to go home the same
day, but some need to stay in hospital overnight.
What are the extra complications of a mid-trimester medical
abortion?
Mid-trimester medical abortions carry additional risks compared
with the early medical abortion and a surgical abortion (see above).
Sometimes during the second visit, after loss of the pregnancy,
the placenta becomes retained in the womb. If this occurs, you
might need an operation under general anaesthetic to remove the
placenta. The risk of heavy bleeding is also greater at this later
stage of pregnancy than during the termination of earlier pregnancies.
What should I expect to experience after a termination?
For the first few days after a termination, you will probably
experience some bleeding from your vagina and might experience
some cramping pains low in your abdomen. You can use a sanitary
towel to protect your clothes from the bleeding, and the pain
can usually be relieved by your usual pain-killers. Sometimes,
there is very little bleeding or no bleeding at all. Please don't
use tampons for this bleeding because they might introduce infection
to your womb.
I am worried about the bleeding and pain after my termination.
After any method of termination, you will probably experience
some bleeding from your vagina. You are more likely to get heavier
bleeding if you were later on in your pregnancy. The bleeding
can continue for up to 14 days but should get less each day. If
the bleeding is very heavy, or persists for longer than 14 days,
then you should seek advice or treatment from your general practitioner
(GP). If this is not possible and your termination was done at
Addenbrooke's contact Ward D6 (Tel: 01223 216 643) for advice
and treatment. If the pain is getting worse or you can't relieve
it with your usual mild pain-killer, then you should also seek
advice and/or treatment.
I am worried I might have an infection after a termination
All surgical procedures carry a small risk of infection. You
are more likely to develop an infection after a termination that
has introduced instruments into your womb ie a surgical termination.
If you develop the following symptoms after a termination, you
might have an infection in your womb:
-
A raised body temperature (greater than 37°C);
-
Smelly vaginal discharge;
-
Pain or discomfort in your lower abdomen that is getting
worse rather than better;
-
Bleeding from your vagina that is increasing rather than
getting better or that has lasted past 14 days after the termination.
How can I reduce the risk of infection after a termination?
To reduce the risk of infection, after a termination don't use
tampons during the subsequent bleeding - you can use them again
for your next proper period. It is also not a good idea to have
long, soaking baths, as the bath water will get into your vagina
- shower if possible, or take a quick dip in the bath..
What should I do if I have an infection after a termination?
If you have any of the symptoms of an infection (listed above),
don't panic. Contact your general practitioner (GP) who can offer
you some advice and treatment. If this is not possible, and you
had your termination at Addenbrooke's, contact Ward D6 (Tel: 01223
216 643).
Will I need a check up after the termination?
It is important that you make a check-up appointment 2 to 3 weeks
after the termination. It is best if you make this with the doctor
who referred you to the termination clinic ie your general practitioner
(GP) or the family planning clinic. They will ask you questions
about how you are feeling, whether you have any symptoms and,
if they feel it is necessary, they will examine you. You probably
won't have had your first period by this time and it is not worth
doing a pregnancy test because it would still be positive from
before the termination. If you need advice about contraception,
this is a good opportunity to ask for advice.
I am worried I will get pregnant again after my termination
Many women are worried that if their method of contraception
has let them down once then it might happen again. Others decide
they want to review their options and might change their method
of contraception. The staff in the termination clinic can
start you thinking about this, and give you information leaflets
if you wish. You can discuss contraception further with your general
practitioner (GP) or at your family planning clinic, when you
go for your check up (see above).
How will I feel emotionally after a termination?
In the first few days after a termination, your feelings can
be quite mixed up. This is partly the result of what can seem
a stressful experience and partly due to hormonal changes. Having
someone to support you through this time can be very helpful,
whether it be from your partner, family or friends. If you find
that you continue to feel distressed after this time, and talking
to those close to you doesn't seem to make much difference, then
contact your general practitioner (GP) or your family planning
clinic for advice or help.
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