Medical termination of pregnancy in hospital

This leaflet tells you what to expect during and after a medical termination of pregnancy (abortion), which is available to women up to 18 weeks pregnant.

Our staff understand that having a termination of pregnancy is a very difficult and emotional decision to make and they will support you and treat you with respect throughout.

The clinic has a strict code of confidentiality. Any personal information you give will be carefully protected, although, if you are under 16 years of age we would recommend that you inform your parents or another supportive adult.

Information will only be shared with the staff involved in your care and the only reason we would consider passing on confidential information without your permission, would be to protect you or someone else from serious harm.

Medical termination of pregnancy (MTOP)

Telephone consultation

A Specialist Nurse will contact you by telephone before your clinic appointment. During your telephone consultation you need to be on your own and somewhere safe where you can speak openly. A Specialist Nurse will confirm your personal details, take a medical history and discuss your treatment options.

We will also talk about your future contraceptive needs and sexual health screening.  A follow-up appointment will then be booked with the doctor.

You will be asked to confirm your contact telephone number in case we need to contact you.

A medical termination has 2 stages:

Clinic appointment
Stage 1

You will be seen by the nurse who will take your temperature, blood pressure, pulse and oxygen saturation levels. Check your weight and height.

A self-taken low vaginal swab will be offered at the appointment to test for chlamydia and gonorrhoea.

You will be seen by the doctor who will perform a scan to confirm how many weeks pregnant you are.  You will be chaperoned by the nurse throughout this procedure.  If you are sure you wish to proceed, your written consent will be obtained and the legal documents completed.

You must be certain before going ahead with a medical termination, as the tablet alone, could result in miscarriage or pregnancy complications if the pregnancy is continued.  If you are at all unsure about having your pregnancy terminated, please let your nurse know.  If you need more time, another appointment will be arranged.  You will be given time to make up your mind.

You will be asked to swallow a tablet (Mifepristone) which acts against progesterone, the hormone that supports an early pregnancy. If you are sick within 1 hour of taking this tablet, you will need to contact the clinic, or ward, and return for another tablet that day.

After taking this tablet you can go home and you will be given a date and time to attend the ward 48 hours later for Stage 2 of the procedure.

The days between visits can be spent in your normal way. You may get some period-like cramp pains and / or some light vaginal bleeding. Taking paracetamol according to the manufacturer’s instructions can help.

If you do have some bleeding you should use sanitary pads, not tampons, to reduce the risk of infection. Your bleeding may become heavy with clots and some pregnancy tissue may be passed.

You are advised not to drink alcohol, and to stop or reduce smoking during your treatment as this may increase bleeding.

You are advised to attend the ward in comfortable clothes and to bring a spare set with you, as well as sanitary pads.

Stage 2

You will be asked to come into hospital for Stage 2 of the treatment, 36 to 48 hours after taking Mifepristone (the first tablet). 

Once you have been admitted to the ward, you will start Stage 2 by the insertion of 4 Misoprostol tablets into your vagina. These tablets will make your uterus (womb) start to contract.

If the pregnancy has not passed after 3 hours, you will be given further doses of Misoprostol to be taken by mouth, up to a maximum of four doses.  There is a possibility you may have to stay in hospital overnight until the procedure is complete.   

We recommend that you wear comfortable clothing and bring toiletries into hospital with you.

You will be asked to use bedpans every time you go to the toilet and your nurse will tell you if you have passed the pregnancy.

Each woman’s experience is different. A mild to strong period pain may be felt, together with vaginal bleeding.  Some women may have vomiting (being sick), diarrhoea, severe pain and heavy vaginal bleeding. We can give you tablets or an injection to ease your pain and vomiting if you need them. Any diarrhoea usually stops as soon as your pregnancy tissue is passed.

Depending on the stage of pregnancy, you may be able to recognise the pregnancy tissue as the early development of a baby (embryo).  If you do not want to see this, please let the staff know and they will do all they can to remove the bedpan discreetly.

All pregnancy tissue is blessed by the hospital chaplain (this is a multi-faith blessing).  It is then cremated with dignity and respect at a crematorium. 

You will be given further information about this at the time and you will be asked for written consent.

Are there any risks and possible complications in having a medical termination of pregnancy?

There are some risks and possible complications you need to consider before you agree to proceed.

These include:

• Very heavy bleeding at the time of the procedure. This is rare, but can happen to 1 woman in every 1000 having a medical termination of pregnancy.¹

• Post-termination infection. This can happen to 1 woman in every 10.²

• Incomplete evacuation of the uterus. This means that some pregnancy tissue may have been left behind and further tests or treatment will be needed. This occurs in 7 women in every 100 undergoing MTOP.⁴

• Failed termination (ongoing pregnancy). The procedure fails in less than 1 woman in every 100.¹ If this happens further treatment will be needed.

• Uterine perforation (making a hole in the womb). This is rare, but can happen to 1 in every 1000 women having MTOP.² If this happens a laparotomy (open operation involving a cut in your tummy) would be required to check for, and repair, any organs, such as the bowel.

• Rupture of Caesarean section scar. This happens very rarely but would require an urgent laparotomy (open operation) involving an incision (cut) in the abdomen (tummy) to repair the scar or remove your womb, if the bleeding cannot be controlled.

• Psychological (mental) distress. This is common before and immediately after a termination. Only a small number of women have long-term distress.² If you do feel upset, it often helps to talk to someone. Please ring the counsellor or Pregnancy Advisory Clinic (PAC) nurse.

• Future pregnancies. There is no evidence that following a medical termination of pregnancy, women suffer from subsequent ectopic pregnancy (pregnancy outside the womb), placenta praevia (low lying placenta) or infertility.¹  However, abortion is associated with a small increase in the risk of subsequent premature birth, which increases with the number of abortions.³

What about contraception (family planning)?

You should not have sex for 2 weeks after your termination or until your bleeding has stopped.

It is vital you start some form of contraception as soon as possible after your termination.  It is possible to get pregnant before your next period.

Your nurse will discuss all the choices with you and give you information leaflets.  If you decide to use the:

• Depo-provera (contraceptive injection). This can be given on the ward before you go home. The injection lasts for 12 weeks, after which you will need to have another one.

• Oral contraceptive pill. The first tablet should be taken that night or the next morning. You will be given a supply before you leave the ward.

• Intrauterine coil – non hormonal/hormonal. We can arrange an appointment for this to be fitted in Women’s Outpatients at University Hospital of Hartlepool or you can be referred to the Contraception and Sexual Health (CASH) clinic, or you could go to your GP. You must use another type of contraceptive until your coil is fitted.

• Nexplanon (a contraceptive implant). This should be inserted within 5 days of your termination. We can arrange for it to be fitted in the PAC clinic or you will need to attend a CASH clinic, or your GP. You must use another form of contraception until the implant is inserted.

• Evra contraceptive patch. This may be applied on the day of your termination and will last for 7 days before a new patch should be applied. After 3 weeks use of patches you will need to wait 7 days before applying the patches again.

A supply of condoms will be given to you before you leave the ward if you need them.

You must contact the ward if:

• The pain becomes severe.
• Your bleeding is very heavy, for example soaking sanitary pads.
• Your vaginal loss starts to smell.
• You have a temperature over 37.5°C (99.5°F).

If you have any worries or concerns within the first 6 weeks do not hesitate to contact us (see contact numbers at the end of this leaflet).

Contacts numbers

Pregnancy Advisory Clinic (North Tees)
Monday – Friday 8.00am – 4.00pm

Non-urgent messages can be left on the answering machine outside these hours and will be returned during the next working day.
Advice Line: 01642 624320
Appointments: 01642 624233

Pregnancy Advisory Clinic (Hartlepool)
Monday – Friday 8.00am – 4.00pm

Non-urgent messages can be left on the answering machine outside these hours and will be returned during the next working day.

Appointments and advice: 01429 522751

For emergency advice, contact:

Surgical Decisions Unit
24 hours a day, 7 days a week.
Telephone: 01642 617617 extension. 46430

Unit Counsellor
Monday – Friday, 9.00am – 5.00pm

Non-urgent messages can be left on the answering machine.

01642 624236

Further information available:

Royal College of Obstetricians & Gynaecologists
10-18 Union Street
London
SE1 1SZ
Telephone: 020 7772 6200
Website: www.rcog.org.uk

NHS Choices
Calls to this number are free from landlines and mobile phones.
When it is less urgent than 999 call 111
Website: www.nhs.uk

Specialist Stop Smoking Service (Incorporating, Middlesbrough, Redcar and Cleveland, Stockton and Hartlepool)
Monday – Friday, 9.00am – 5.00pm
Telephone: 01642 383819

Useful telephone numbers and addresses:

Sexual Health Teesside
Telephone: 0300 330 1122

HIV Support Services – Terence Higgins Trust
Telephone: 0808 802 1221

Sexual Assault Referral Centre (SARC) Teesside – Helen Britton House
Telephone: 01642 516888

Domestic Violence Services – Harbour
Telephone: 03000 202525
Website: www.facebook.com/harboursupportservices

My Sister’s Place
123 Borough Road
Middlesbrough
TS1 3AN
Telephone: 01642 241864
E Mail: [email protected]

Lawson Street Health Centre
Lawson Street
Stockton-on-Tees
TS18 1HU

Hartlepool One Life
Park Road
Hartlepool
TS24 7PW

Live Well Centre
Dundas Arcade
Dundas Street
Middlesbrough
TS1 1HR

Redcar and Cleveland Community Heart
Ridley Street
Redcar
TS10 1HU

References

1. https://www.rcog.org.uk/en/guidelines-research-services/guidelines/comprehensive-postabortion-care-best-practice-paper-no.-3/
2. https://www.rcog.org.uk/en/patients/patient-leaflets/abortion-care/
3. https://www.rcog.org.uk/en/guidelines-research-services/guidelines/the-care-of-women-requesting-induced-abortion/
4. https://www.nice.org.uk/guidance/ng140/resources/patient-decision-aid-pdf-6906582255

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

Freephone: 0800 092 0084

Opening hours: Monday to Friday, 9:30am to 4:00pm

Email: [email protected]

Out of hours

Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard who will bleep the appropriate person.

Telephone: 01642 617617

Data protection and use of patient information

The Trust has developed Data Protection policies in accordance with Data Protection Legislation (UK General Data Protection Regulations and Data Protection Act 2018) and the Freedom of Information Act 2000. All of our staff respect these policies and confidentiality is adhered to at all times. If you require further information on how we process your information please see our Privacy Notices.

Telephone: 01642 383551

Email: [email protected]

Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

Email: [email protected]

Leaflet Reference: PIL1277
Date for Review: 22/07/2024