Medical Termination of Pregnancy (MTOP) – at Home

Introduction

This leaflet tells you what to expect during and after a medical termination of pregnancy (abortion) at home which is available to women up to 10 weeks pregnant with no underlying medical conditions.

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.

There is also a counsellor available, someone trained to listen and help you to make decisions, who can offer you support should you need it at any time.

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.

Telephone consultation

During this you need to be on your own, 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 contraception needs and Sexual Health screening. A follow-up appointment will then be booked with the doctor.

Stages

A medical termination of pregnancy has 2 stages:

Clinic appointment / Stage 1

You will be seen by the nurse who will take your temperature, blood pressure, pulse and oxygen saturations, and 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 want to proceed, your written consent will be obtained and the legal documentation 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 prescription to go to the hospital pharmacy for the medication for you to administer the second part of the treatment at home. You will be given an instruction leaflet and a copy of your self-assessment form.

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. 

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

If you have any worries or concerns, you can contact the ward at any time.

It is advisable to make arrangements for a suitable adult to be with you throughout the second stage of the procedure. It is also advisable that you ensure you have access to a telephone and transport, in case you need to return to the hospital urgently.

Stage 2

The nurse will advise you when to start stage 2, which will be 36 to 48 hours after taking the first tablet (Mifepristone). You have to insert four tablets (Misoprostol) into your vagina as high as possible.  You can do this in any position – standing with one leg up, squatting or lying down, whatever is easiest and more comfortable for you.

Most women pass the pregnancy within four hours, but sometimes it can take up to a few days. 

After 3 hours, if you are not aware you have passed the pregnancy, take a further 2 tablets of Misoprostol by mouth (if you don’t use these tablets, don’t throw them away, please return them to a pharmacy).

Each woman’s experience is different. A mild to strong period pain may be felt, together with vaginal bleeding, and then the pregnancy tissue is passed. Some women may have vomiting (being sick), diarrhoea, severe pain and heavy vaginal bleeding.  

Any diarrhoea usually stops as soon as your pregnancy tissue is passed. You will need to ensure that you have a supply of painkillers such as Ibuprofen and Co-Codamol at home to relieve any discomfort.

Bleeding is usually heavier than a period and you may pass some blood clots. You must wear sanitary towels and not use tampons.  Depending on the stage of the pregnancy, you may be able to recognise the pregnancy tissue as the early development of a baby (embryo).

Once the pregnancy has passed, the bleeding and cramp-like pains will reduce. It is likely you will have cramp-like pains on and off for a week, but this can be managed with Paracetamol and Ibuprofen.

If at any time you experience excessive pain and / or heavy bleeding i.e. soaking pads every 30 minutes for 2 hours or more, then you must contact the Ward straight away.

You will be offered a telephone review after 6 hours, if you have had no pain or bleeding, a further telephone assessment will be made in 24 to 48 hours.

If at this time, you have had pain and bleeding you will be asked to carry out a pregnancy test in 3 weeks. If on the other hand, you still have had no pain and bleeding, they will arrange for you to have a scan in 1 week to see if you require further treatment.

It is possible to get pregnant immediately after termination of pregnancy, so it is important to have your chosen method of contraception ready. Depo-provera can be given on the same day as treatment.

A prescription for the contraceptive pill or patch can be given to start when your pregnancy test is negative. Alternatively, the insertion of a coil or implant can be arranged at the hospital, GP surgery or Contraceptive and Sexual Health clinic.

You must contact the ward if:

• your vaginal loss starts to smell

• you have a temperature over 37.5ºC (99.5ºF).

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).

Are there any risks and possible complications related to termination of pregnancy?

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

The risks and possible complications 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 1 woman in every 100.²  If this happens, a review appointment will be arranged to discuss further options.
• 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 your 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

Contact numbers

Pregnancy Advisory Clinic (North Tees)

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

Appointments: 01642 624233

Advice line: 01642 624320

Opening hours: 8:00am to 4:00pm (Monday to Friday)

Pregnancy Advisory Clinic (Hartlepool)

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

Opening hours: 8:00am to 4:00pm (Monday to Friday)

Unit Counsellor

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

Telephone: 01642 624236

Opening hours: 9:00am to 5:00pm (Monday to Friday)

Further information is available from:

Royal College of Obstetricians & Gynaecologists

10-18 Union Street

London

SE1 1SZ

Telephone: 0207 772 6200

Specialist Stop Smoking Service

Incorporating Middlesbrough, Redcar and Cleveland, Stockton and Hartlepool.

Telephone: 01642 383819

Opening hours: 9:00am to 5:00pm (Monday to Friday)

NHS Choices

Telephone: 111 (when it is less urgent than 999).

Calls to this number are free from landlines and mobile phones or via the website.

Useful addresses

Sexual Health Teesside

Telephone: 0300 330 1122

Live Well Centre

Dundas Arcade
Dundas Street
Middlesbrough
TS1 1HR

Redcar and Cleveland Community Heart

Ridley Street
Redcar
TS10 1HU

Hartlepool One Life

Park Road
Hartlepool
TS24 7PW

Lawson Street Health Centre

Lawson Street
Stockton-on-Tees
TS18 1HU

Sexual Assault Referral Centre (SARC) Teesside – Helen Britton House

Telephone: 01642 516888

HIV Support Services – Terence Higgins Trust

Telephone: 0808 802 1221

Domestic Violence Services – Harbour

Telephone: 03000 202525

My Sister’s Place

123 Borough Road
Middlesbrough
TS1 3AN

Telephone: 01642 241864

Email: [email protected]

References

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]