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 significant 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.

Medical Termination of Pregnancy (MTOP) at home

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, somewhere safe where you can speak openly.

The 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 again.

The MTOP procedure has 2 stages.

Clinic appointment/Stage 1

You will be seen by a 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.

You will be seen by the doctor who will perform a scan to confirm how many weeks pregnant you are. There will also be a Nurse to accompany you during this scan.

After the scan you will be asked if you wish to proceed. If you do want to continue you will give written consent, and any legal documents will be completed.

You must be certain before going ahead with a medical termination as the tablet alone could cause a miscarriage or 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, which is a hormone that supports an early pregnancy. If you are sick within 45 minutes of taking this tablet you will need to contact the clinic, or ward, and return for another tablet that day.

After taking the Mifepristone 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 including a copy of your self-assessment form.

The days between your visits can be spent in your normal way. You may get some period-like cramp pains, and/or some light vaginal bleeding. Taking Paracetamol (always making sure you stick to the recommended doses on the packaging) can help.

If you do have some bleeding you should use sanitary pads, not tampons. This is to reduce the risk of infection that can be caused with tampons. 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.

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 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 sanitary pads every 30 minutes for 2 hours or more, then you must contact the ward straight away (see contact numbers).

On completion of the treatment if you have had pain and bleeding you must carry out a pregnancy test in 3 weeks. If on the hand you have had no pain or bleeding up to 48 hour after completing your treatment, you must contact the ward for advice.

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

A prescription for the contraceptive pill or patch can be given to start immediately following treatment. Alternatively the insertion of a coil or implant can be arranged at the hospital, GP surgery, or Contraceptive and Sexual Health clinic.

Things to look out for when you get home

You must contact the ward if:

• Your vaginal loss starts to smell.

• You have a temperature over 37.5°C.

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

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

There are some risks and possible complications that 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 an MTOP.² If this happens a laparotomy (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 (C-section) scar. This only happens if you have had a previous C-section, and is very rare. If this happens you will need a laparotomy (surgery) to repair the scar, or possibly to remove your womb if the bleeding could not 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 for advice and help.

• Future pregnancies. There is no evidence that following an MTOP women suffer from subsequent ectopic pregnancy (pregnancy outside the womb), or placenta praevia (low lying placenta), or infertility (inability to get pregnant).¹

However MTOP is associated with a small increase in the risk of subsequent premature birth, which increases with the risk of abortions.³

If you would like any further advice or to discuss the risks please use the websites or contact the department using the information further on in the leaflet.

Contacts numbers

Pregnancy Advisory Clinic (North Tees)
Appointments: 01642 624233
Advice line: 01642 624320
Monday to Friday, 8.00am to 4.00pm

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

Pregnancy Advisory Clinic (Hartlepool)

Appointments and Advice: 01429 522751
Monday to Friday, 8.00am to 4.00pm

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

For emergency advice contact:

Surgical Decisions Unit
Telephone: 01642 624566 or 01642 624628
24 hours a day, 7 days a week

Unit Counsellor
Telephone: 01642 624236
Monday to Friday, 9.00am to 5.00pm

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

Further information available:

Royal College of Obstetricians and Gynaecologists
www.rcog.org.uk
https://www.rcog.org.uk/for-the-public/browse-our-patient-information/abortion-care

NHS Website
www.nhs.uk
https://www.nhs.uk/conditions/abortion/what-happens

Useful websites or addresses

Sexual Health Teesside
https://www.teessidetogether.co.uk/
Telephone: 0300 330 1122

Middlesbrough: Live Well Centre, Cleveland Centre, TS1 2NR

Hartlepool: Fens Medical Centre, 434 Catcote Road, TS25 2LS

Redcar: Community Heart, Ground Floor, Ridley Street, TS10 1TD

Stockton: Lawson Street Health Centre, Lawson Street, TS18 1HU

Terrence Higgins Trust (for HIV support)
www.tht.org.uk
Telephone: 0808 802 1221
Email: [email protected]

Harbour Domestic Abuse Support
www.myharbour.org.uk
Telephone: 03000 202525
Email: [email protected]

My Sister’s Place
www.mysistersplace.org.uk
Telephone: 01642 241864
Email: [email protected]

Specialist Stop Smoking Service
Telephone: 01642 383819

References

1. Best practice in post-abortion care (Best Practice Paper) | RCOG
2. Abortion care | RCOG
3. The Care of Women Requesting Induced Abortion | RCOG
4. NG140 Patient decision aid on abortion before 14 weeks (nice.org.uk)
5. P04.02: Medical termination of pregnancy after Caesarean section

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 Team is here to try to resolve your concerns. The office is based at the University Hospital of North Tees if you wish to discuss concerns in person. Our contact details are:

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

Patient, Public and People with Lived Experience

We are looking for patients to share their experiences of healthcare and to join our Involvement Bank. Working with the patients, carers, families and the general population we support in making decisions about their care can lead to better health outcomes, increased patient satisfaction and a better overall experience. We want to listen and work with you in shaping the future of your healthcare services. To find out more about the Involvement Bank go to our website or contact us at:

Website: www.nth.nhs.uk/about/community/people-with-lived-experience
Email: [email protected]

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]Privacy Notices

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 at:

Email: [email protected]