Abortion procedures

Medical abortion

Medical abortion uses pills rather than surgery. Early medical abortion is more like a natural miscarriage. A later medical abortion is more like inducing a labour.

What is medical abortion?

Medical abortion is a way to end pregnancy without surgery, and is like having a miscarriage.

It falls into two categories. Early medical abortion performed up to 9 weeks of pregnancy induces a miscarriage. Second trimester medical abortion is performed later in pregnancy to put a woman into early labour.

The availability of medical abortion varies around the country, check you local provider for details.
 

Early medical abortion

Available up to nine weeks (63 days) after the beginning of the last menstrual period.

 

The treatment

The treatment will usually consist of one Mifegyne® tablet. This acts by blocking the effects of progesterone, a hormone which is needed for pregnancy to continue.

This will be followed zero to 48 hourrs later by the insertion into the vagina, or inside the mouth, four tablets of Cytotec® (misoprostol). This is a different type of hormone, a prostaglandin, that helps to expel the pregnancy. The timing of this medicine depends on a number of factors including the age of your pregnancy, your local clinics protocols, and your preference. In any cases this second medicine will need to be taken either later in the day or within the next two days for medical reasons.

In New Zealand the law requires that both these medications are taken in the abortion clinic. However, it is usual for the patient to go home after taking the medicine for the miscarriage to occur.

 

Who can use this treatment?

Most women can have the treatment. However it is not suitable:

  • if there is an ectopic pregnancy (where the egg has implanted in the tube rather than in the womb).

  • if the first day of the last normal menstrual period was more than 63 days ago. The doctor can confirm the age of the pregnancy with an ultrasound scan.

  • if you have ever had a bad reaction or are allergic to the drugs used in a medication abortion: mifepristone (Mifegyne®) or misoprostol (Cytotec®).

  • if an intrauterine contraceptive device (IUD) is in place. This must be removed before taking Mifegyne®.

In some other circumstances the treatment may also be unsuitable so the doctor must be advised:

  • if you have a medical condition such as a heart complaint, high blood pressure or diabetes.

  • if you suffer badly from asthma or are on long-term steroid treatment for any other reason.

  • if you are anaemic or have a bleeding disorder or are receiving anticoagulants.

The doctor will discuss whether the treatment is suitable and what your options are.

 

Some other precautions

  • The treatment is not suitable if you do not have a telephone or you live more than one hour from emergency hospital medical services. This is in case of heavy bleeding needing emergency treatment.

  • The treatment is not suitable if you are unsure about the decision to have an abortion because once the Mifegyne® is taken there is a risk that if the pregnancy continues the baby may be born with abnormalities. Difficulties in making a decision must be discussed with the doctor, nurse/midwife or counsellor.

  • If you are breast feeding you should stop for at least five hours after taking Mifegyne® and throw away the milk produced in that time.

  • You should not drink alcohol or smoke once the Mifegyne® has been taken and for at least two days after taking the vaginal tablets. Recreational drugs or herbal preparations, such as St John's Wort, should not be taken.

  • If you are taking other medicines the doctor must be advised. Some medicines may interfere with the treatment.

 

What are the effects of treatment?

  • After taking the initial Mifegyne® tablet nothing much will happen for about 12 hours.

  • After 12 hours you may start to bleed. Though do not worry if there is no bleeding.

  • After being given the second Cytotec® tablets, bleeding should start within the next few hours and you will usually get stomach pain and cramps which may be quite strong. A medical abortion is like having a miscarriage. In some cases the bleeding can be very heavy and in a very small number of cases (about 1 in 300) it may be necessary to give a blood transfusion and/or perform a surgical abortion to stop the bleeding.

  • The doctor will have prescribed painkillers to manage the pain. Pain can be worse if you have never been pregnant before or if you normally suffer from painful periods. Most women cope very well with the pain in their own homes.

  • Other effects of the second Cytotec® medicines can be diarrhoea, sickness, headache, dizziness, hot flushes and chills. Any concerns you have must be reported to the nurse/midwife or doctor.

  • In over 90% of cases the pregnancy will be expelled in the six hours after taking the vaginal tablets. If the medical treatment fails a surgical abortion will be necessary; this only happens in less than 5% of cases.

  • Many women ask if they will be able to see the embryo. The sac and the placenta surrounding the embryo can be seen clearly but the embryo at this stage is usually too small to be seen.

  • You should have a good supply of maxi-pads. The miscarriage will either occur into your pad, or into the toilet bowl if you decide to rest on the toilet during the heaviest part of the miscarriage.

 

Follow-up

  • Most women will pass the tissue at home. In this case arrangements will be made to have blood tests and possibly another ultrasound examination to confirm that the abortion is complete. You are recommended to see your referring doctor for a final check in 10-14 days for any problems and for ongoing contraceptive care.

  • If the pregnancy tissue has been passed in the clinic, you will be given an appointment with your referring doctor for a final check-up in 10-14 days to make sure that you are well and have suffered no complications.

  • The follow-up tests to confirm that the pregnancy has ended are most important. The clinic will make an effort to contact you if you do not attend for the tests. Bleeding and cramping are not proof that the abortion is complete.

 

What about contraception?

  • A plan for future birth control should be discussed with the clinic medical staff.

  • It is possible to become pregnant again immediately after the abortion is complete, so that contraception, such as oral contraceptives, should be started within five days of taking the Mifegyne®.

  • Contraceptive implants can be inserted before the woman takes the second medication.

  • An IUD can be inserted a week after the medical abortion is complete.

  • You are advised not to have sex for 14 days.

 

If the woman is Rh negative

  • The routine tests by the referring doctor will have checked the blood group. If the blood group is Rh negative you will be given an injection to stop antibodies forming which could be a problem if you ever become pregnant again.

 

What to expect after going home

  • You will be advised not to put anything into the vagina for 14 days i.e. no tampons, no sex, no bathing or swimming.

  • A small number of women may develop an infection. This may cause a temperature, or pain, discharge or unusual bleeding. A doctor should be consulted if this occurs so that antibiotics can be given, if needed.

  • You may continue to bleed for several weeks. If the bleeding is heavy (more than two maxi-pads an hour for two hours) you should ring the clinic, the referring doctor or emergency hospital medical services.

  • You should recover quickly from the abortion but will be advised to take things easy for a few days and avoid aerobic exercise for two weeks. You may feel emotional and extra counselling may be needed.

  • Menstrual period may re-establish in four to eight weeks.

 

Second trimester medical abortion

In the second trimester of pregnancy (after 12 weeks) a pregnancy is aborted medically by inducing labour. This process has been used for many years in NZ as an alternative to late surgical abortion.

The treatment consists of two different pills Mifegyne® (mifepristone) followed by Cytotec® (a prostaglandin). The process is similar to that with early medical abortion except that it is likely to take longer and be more painful.

 

The treatment

Mifegyne® (mifepristone) is the first medication.This acts by blocking the effects of progesterone, a hormone which is needed for pregnancy to continue.

This will be followed 24 to 48 hours later by a course of prostaglandin, usually Cytotec® (misoprostol). The dose, frequency and method of delivery of the drugs varies from clinic to clinic. This prostaglandin acts on the uterus in a number of ways to induce contractions that expel the pregnancy.

 

Who can use this treatment?

Most women can have the treatment but it is important that the doctor knows your full medical history.

 

How is the treatment taken?

  • You will be given one to three tablets of Mifegyne® to swallow with some water, which must be taken at the hospital/clinic. You will be able to go home after taking the tablet.

  • You need a good supply of maxi-pads for use at home.

  • If there is any cause for concern such as heavy bleeding, the clinic must be consulted for advice. There should be a 24 hour telephone service for any emergencies. In a few cases the abortion may occur after Mifegyne® alone.

  • You will be given an appointment to return to the clinic 24 to 48 hours later and (except in those women who have already aborted) the course of prostaglandin will be begun. This may be oral or vaginal tablets. The dose will be repeated every few hours until the fetus is delivered.

  • After a variable time contractions will start and the cervix (neck of the womb) will dilate similar to a labour. Most women find these contractions painful and are likely to need pain relief.

 

What are the effects of treatment?

  • After taking the Mifegyne® tablet nothing much will happen for about 12 hours.

  • After 12 hours you may start to bleed. Though do not worry if there is no bleeding.

  • After being given the prostaglandin, if bleeding has not already started, it will now start and most women will get stomach pain and cramps which may be quite strong. A second trimester medical abortion is like having a labour. In some cases the bleeding can be very heavy and in a very small number of cases (about 1 in 300) it may be necessary to give a blood transfusion and other drugs which contract the uterus.

  • If there is a lot of pain the doctor will prescribe painkillers.

  • The average time taken to expel the pregnancy is about eight hours after the prostaglandin pills. However, a number of women will need to have a second course of prostaglandin the next day and occasionally on the third day.

  • A number of women do not pass the placenta after the fetus and require a surgical procedure to assist with this (retained placenta).

 

Follow-up

  • You should be given an appointment for a follow-up check one to two weeks after the abortion either with the clinic or with her referring doctor/specialist.

  • If the reason for the termination is a fetal anomaly arrangements will be made to review any post-mortem findings with the parents.

 

What about contraception?

  • A plan for future birth control should be discussed with the doctor.

  • It is possible to become pregnant again immediately after the abortion is complete, so that contraception, such as oral contraceptives, within five days of taking the Mifegyne®.

  • An implant can be inserted after the first medication.

  • An IUD can be inserted from one week after the abortion.

  • You are advised not to have sex for 14 days after the abortion is complete.

 

If the woman is Rh negative

  • The routine tests by the referring doctor will have checked the blood group. If the blood group is Rh negative you will be given an injection to stop antibodies forming which could be a problem if she ever becomes pregnant again.

 

What to expect after going home

  • You will be advised not to put anything into the vagina for 14 days i.e. no tampons, no sex, no bathing or swimming.

  • A small number of women may develop an infection. This may cause a temperature, or pain, discharge or unusual bleeding. A doctor should be consulted if this occurs so that antibiotics can be given, if needed.

  • You may continue to bleed for several weeks. If the bleeding is heavy (more than two maxi-pads an hour for two hours) you should ring the clinic, the referring doctor or emergency hospital medical services.

  • You should recover quickly from the abortion but will be advised to take things easy for a few days. You may feel emotional and extra counselling is available if needed. You should have a regular period in four to eight weeks.