Pregnancy Loss

This leaflet has been produced to give you general information about what will happen following pregnancy loss. Some of your questions will be answered by this leaflet. It is not intended to replace the discussion between you and your Doctor / Midwife, but may act as a starting point for discussion.

If after reading this leaflet you have any concerns or require further explanations, please discuss this with a member of the healthcare team who is caring for you.

What will happen next?

At the Antenatal Day Assessment Unit

A Midwife will check your personal details, document any allergies and discuss any concerns or questions you may have. The Midwife will then take your blood pressure, temperature, pulse and respiration rate (vital signs).

The Midwife will then ask to take a sample of your blood to check your iron level and blood group. If you are Rhesus negative, you may be offered an injection. The Midwife will then discuss taking Mifepristone with you.

What is Mifepristone?

Mifepristone is a tablet which acts by blocking the effects of progesterone, a hormone which is needed for a pregnancy to continue. It makes the uterus (womb) sensitive to contractions and helps soften the cervix (neck of the womb). The Mifepristone tablets can be swallowed with water.

It is important to inform you that Mifepristone does not have a UK licence for use in pregnancy, but is a recognised and approved drug of choice for effectively managing pregnancy loss. This can be discussed fully with your Doctor / Midwife.

Possible side effects

Very common side-effects (in over 10:100 women):

• Uterine contractions (like labour pains)
• Cramping
• Nausea
• Vomiting
• Diarrhoea

Common side-effects (in less than 10:100 women):

• Heavy bleeding
• Infection following birth
• Light or moderate stomach cramps

Uncommon side-effects (in less than 1:100 women):

• Skin rashes
• Fall in blood pressure

Rare side-effects (less than 1:100 women):

• Headaches
• Malaise (feeling tired)
• Hot flushes
• Dizziness
• Chills
• Fever
• Hives
• Serious skin disorder

What happens after taking Mifepristone?

If you are sick within two hours of taking the tablets, please telephone the Antenatal Day Assessment Unit or the Delivery Suite for advice.

You may experience some backache or mild period type pains prior to your admission to Delivery Suite. This can be helped by taking paracetamol. If the discomfort worsens or if you have any vaginal bleeding, telephone the Delivery Suite and ask to speak to a Midwife who will be able to give you advice.

While at home, eat and drink as normal. Try to rest and pack the things that you may need for your stay in hospital. The process can take anything from hours to a few days. Your family can come and visit / support you during this time.

Admission to The Delivery Suite

The Midwife will give you a date and estimated time to come into the Delivery Suite for the next part of the process. Usually, this is around 48 hours after taking the Mifepristone. We ask that you ring The Delivery Suite before your admission to confirm a suitable time for you to come in.

What will happen at The Delivery Suite?

The Delivery Suite is located on the second floor of the University Hospital of North Tees.

You will be welcomed by a Midwife who will be caring for you and your birth partner. You will be orientated to the ward and your room and given time to settle in.

Following your arrival, your Midwife will obtain a brief history and discuss your options for care.

They will confirm with you that your personal details are correct and will check your weight and vital signs.

When you feel ready, your Midwife will discuss the next part of the process. This is done using Misoprostol tablets which may be taken orally or by placing the tablet high up in the vagina near the cervix. The Midwife will discuss the two options for administration with you.

The action of the Misoprostol is to soften the cervix in preparation for labour.

It is important to realise that you will probably not go into labour straightaway, although this sometimes does happen. The tablets are given every 6 hours over a 24-hour period. A maximum of 4 tablets are given.

If you have not given birth after 24 hours, a senior Doctor will make a further plan. The usual practice is to allow you to rest for a 24-hour period before repeating the process.

Sometimes you may need to have other medication to induce labour. If this is the case your Midwife / Doctor will discuss this thoroughly with you and your birth partner. The Midwives or Doctors will not be able to tell you exactly how long the process will take.

There is a range of pain relief available and your Midwife will discuss your options with you.

Sometimes, complications arise following birth and the Doctor may need to carry out additional procedures. For example, you may require an examination under anaesthetic to ensure that your womb is completely empty (manual removal of placenta). These will be fully explained to you if they become necessary.

Your Midwife will also talk to you about the birth of your baby and your wishes following the birth. You do not have to make any immediate decisions. Your Midwife and the Doctors will allow you as much time as you feel you need.

You will be given the chance, with support from the Midwife, to make memories if you wish to do so. This is a very personal decision and all your choices will be fully respected.

You will remain on The Delivery Suite throughout your stay, which may extend for more than one day. Visiting is unrestricted, but will be guided by how you feel. The Midwives will provide you with support throughout this time.

You will also be supported to make a decision with regard to funeral arrangements for your baby. The Bereavement Support Officer will visit you during your stay to discuss your options.

Our Hospital Chaplaincy service can offer both religious and non-religious support to all faiths. Our Unit Counsellor offers support to bereaved families.

Contact details

If you have any concerns or questions, please do not hesitate to contact:

University Hospital of North Tees

Antenatal Day Assessment Unit

Telephone: 01642 624329

Delivery Suite

Telephone: 01642 382818

Information used in the development of this leaflet

NHS Hull University Teaching Hospital, Information about the administration of Mifepristone (Mifegyne): Ref No. HEY-491/2018. https://www.hey.nhs.uk/patient-leaflet/information-about-the-administration-of-mifepristone-mifegyne/

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]