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 who are up to 18 weeks pregnant.

We understand that having a termination of a pregnancy is a very difficult and emotional decision to make, and our staff will support you and treat you with respect throughout the process.

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/carer or another supportive adult.

Information will only be shared with the staff involved in your care. 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, 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 this tablet you can go home and you will be given an appointment to attend the ward 48 hours later for Stage 2 of the procedure.

You will need to have a blood test before coming into hospital if you are more than 10 weeks pregnant or have other medical conditions.

This blood test will be taken within the phlebotomy department at the hospital following your initial clinic appointment.

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.

It is best when you attend the ward to come in comfortable clothing and to bring a spare set of clothes with you, as well as extra sanitary pads.

Stage 2

You will be asked to come into hospital for Stage 2 of the treatment. This will be 36 to 48 hours after taking the Mifepristone tablet at your first appointment.

Once you have been admitted to the ward you will start Stage 2 of the treatment by putting 4 Misoprostol tablets into your vagina. These tablets will start to make your uterus (womb) 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 that you may have to stay in hospital overnight until the procedure is completed. 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 other symptoms like vomiting (being sick), diarrhoea, severe pain, or heavy vaginal bleeding. When you are in hospital we can give you tablets or an injection to ease some of these symptoms if needed. 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. They will do all that they can to remove the bedpan discreetly without you having to see it.

There are several options available for the embryo once you have passed it. The options will be discussed with you and you will give permission by written consent for whichever option you choose when you are admitted.

Are there any risks and possible complications in having a medical 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 would 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.

What about contraception (family planning)?

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

It is vital that 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 injection.

• 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 or hormonal) an appointment can be arranged for this to be fitted in the Women’s Outpatient clinic at Hartlepool Hospital. You can also be referred to the Contraception and Sexual Health (CASH) clinic or you can 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 this to be fitted in the PAC clinic or you will need to attend a CASH clinic or your GP surgery. 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.

• Condoms a supply will be given to you before you leave the ward if you need them.

Things to look out for when you get home

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.

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

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
www.thesexualhealthhub.co.uk/teesside
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]

Leaflet reference: PIL1277 – Version 2
Date for review: February 2028