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«Obstetrics & Gynaecology Department Author ID: AB Leaflet Number: Gyn 039 Version: 6 Name of Leaflet: Termination of Pregnancy Date Produced: August ...»

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Termination of Pregnancy

Patient Information

Obstetrics & Gynaecology Department

Author ID: AB

Leaflet Number: Gyn 039

Version: 6

Name of Leaflet: Termination of Pregnancy

Date Produced: August 2015

Review Date: August 2017

Termination of Pregnancy Page 1 of 13

You have decided that a termination of pregnancy is the right course of action for you to

take, yet you may still experience feelings of guilt mixed with feelings of relief. There is a counselling service available should you wish to speak to someone and our staff will be happy to give you their contact telephone numbers.

If you are 12 weeks pregnant or less when you attend the clinic, you can choose to have either a Surgical Termination of Pregnancy or a Medical Termination of Pregnancy (non surgical procedure) both of which will be discussed within this leaflet.

Hanover Women’s Healthcare Unit telephone number 01942 264962 / 3 (Monday to Friday 9:00am - 4:30pm). Our out of hour’s telephone number is for Swinley Ward (Wigan) 01942 822568.

Surgical termination of pregnancy Initial visit You will be seen at the termination of pregnancy referral clinic, where you will meet two nurses who specialise in sexual and reproductive health. You will at first be seen by a Nurse Sonographer who will perform an internal vaginal ultrasound scan to confirm the number of weeks you are into your pregnancy. Another nurse will ask you for details about your medical history, if you are taking any tablets or other medications – these might be ones that are prescribed by a GP or bought over the counter at the pharmacy. It may help us if you bring with you details of any medications, for example packaging or repeat prescription forms.

This procedure involves the use of general anaesthesia and the nurse will go on to explain in more detail what will happen from admission to discharge. This procedure will be performed as a day-case. (See below for further details in serious or frequently occurring risks).

You will need to sign two consent forms with the nurse. One consent will be to say you wish to proceed with a surgical termination of pregnancy and the other consent will be to allow for the cremation of foetal tissue after the procedure. (This is discussed below and complies with the Trust policy).

Blood tests will also be taken to check your blood group and to see whether or not your blood count is low.

Please feel free to ask questions during your appointment.

At the end of your clinic appointment you will be given a date and time for your surgical termination of pregnancy procedure.

Termination of Pregnancy Page 2 of 13 Take all your normal medication on the day of your admission with a sip of water. It is important that you stop eating and drinking prior to your procedure and all information with regards to this will be on your admissions letter.

Relatives are not permitted to stay with you on the day of the procedure (unless you are under the age of 16) but we do need a contact number for someone who will be able to collect you on discharge and be responsible for you for 24 hours after the procedure.

Risks It is reassuring to know that this operation is very safe. However, no procedure is

absolutely safe and it is important that you know what the risks are:

 Bleeding – the procedure itself will result in vaginal bleeding. There is a small chance of tearing the cervix which may also cause vaginal bleeding, though this would usually be noticed at the time and repaired.

 Blood transfusion - we will take blood at your clinic visit which the hospital laboratory will process in case you need to have blood urgently cross-matched for a blood transfusion (rare).

 Infection - this is unlikely but you will be discharged with two antibiotics. The first antibiotic is called Metronidazole this is a suppository which will be inserted into your rectum whilst you are still under anaesthetic. The second antibiotic is called Doxycycline which is a course of tablets that you will take orally for seven days after discharge. If after discharge you notice an increase in vaginal bleeding, lower abdominal pain, a raised temperature or a smelly discharge, then contact Hanover Women’s Healthcare Unit on 01942 264962 / 3 for an appointment to see one of the doctors.

 Thrombosis (blood clots in lung/legs) - this is unusual in early terminations of pregnancy.

 Failure to completely empty uterus (retained products) or failure to terminate the pregnancy (rare) - this is more likely before eight weeks of pregnancy, which is why the operation is not normally performed before this time. However, it can rarely happen at later dates so it is important that you contact Hanover Women’s Healthcare Unit on 01942 264962 / 3, to arrange for an appointment if you notice a smelly discharge or you continue to feel pregnant.

 Perforation of the uterus, damage to the cervix or damage to internal organs (rare).

Other procedures in the event of complications occurring:

 Laparoscopy - (camera examination of the abdomen)  Laparotomy - (open abdominal operation)

–  –  –

If you are suffering from symptoms of a cold or sore throat on the day of your admission please ensure that you inform the nurse and anaesthetist.





You will be asked to change into a theatre gown, your dressing gown and slippers for the preparation and transfer to theatre. The Doctor and Anaesthetist will come up to the ward to speak to you prior to your procedure.

If you are younger than 16 years of age, it is your first pregnancy or have never had a vaginal delivery before then it may be slightly more difficult to dilate (open up) the cervix so the doctor may prescribe a drug called Misoprostol, which will be inserted into your vagina by one of the nurses. Its aim is to soften the cervix. Misoprostol has not yet been licensed for this treatment, though we do widely use it for this procedure to reduce the likelihood of causing any damage to the cervix.

A member of staff will walk you down to theatre where you will be met by one of the members of staff in the reception area in theatre. You will then be taken through to the anaesthetic room where a needle will be inserted into the back of your hand and the anaesthetic will be given through this.

The operation will be carried out under general anaesthetic and lasts around 10 minutes.

The contents of the womb will be removed by suction. You will be nursed in the recovery ward for up to one hour before returning back up to the ward. If you experience pain following the operation the nurse in recovery will give you pain relief by either injection or tablet. You may feel slightly drowsy and slightly sick but this should wear off after a few hours. You will then be taken back up onto the ward until your discharge home.

It is quite normal to experience bleeding from your vagina after the procedure. You may also experience some lower back or abdominal pain which again is quite normal but please ask the nursing staff for some pain relief, if you need it.

A light diet will be provided prior to your discharge. After two hours a member of staff will contact the named person to come and collect you to take you home. All relevant discharge information will be discussed with you by your discharge nurse. If, however, it is thought that you are not recovering well, then you will be advised to stay in hospital overnight and this will mean a transfer by ambulance to the Wigan site.

You will be advised not to work, drive or sign any legal documentation for 48 hours after discharge because of the effects of the anaesthetic in your body.

–  –  –

Please feel free to ask questions if you are not sure about anything throughout your admission.

Surgical termination of pregnancy under local anaesthetic (MVA) This is also called MVA, which stands for Manual Vacuum Aspiration. A small hand held device is used to empty out the contents of the uterus after some local anaesthetic has been applied to the cervix (neck of the womb).

This procedure offers an additional choice to women who want surgical termination of pregnancy but want to avoid having a general anaesthetic.

What happens?

If you decide to have the MVA, you will be given an appointment to attend ward 2 at Leigh Infirmary Hospital to have the procedure. You can eat and drink normally before you attend. You may be given tablets or vaginal pessaries before the procedure to soften the cervix, along with pain relief. The doctor will meet you and go through any questions that you may have. You will be asked to sign a consent form. A nurse or a health care assistant will stay with you throughout the procedure. They will assist the doctor and provide reassurance and support. A local anaesthetic is injected into the cervix and/or the cervix may be numbed with a gel. The cervix is then dilated (stretched) gradually. A narrow suction tube is then inserted into the uterus to remove the pregnancy tissue. At this stage you will experience a period like pain. The whole procedure will take about 10 -15 minutes.

Once the procedure is complete, an antibiotic (Metronidazole) is given rectally or orally.

After the procedure After the procedure, you can rest in a recovery area with refreshments until you feel able to go home (usually you are fine to leave within an hour, but you may need to stay longer).

You may experience some period like pains after the procedure. Pain killers are available if you need them

Does it hurt?

If you are given tablets or vaginal pessaries before the operation, you might feel discomfort as the cervix opens. Most women have period type pain during the procedure. You will be given painkillers if necessary and the discomfort probably won’t last long. You may have some light vaginal bleeding afterwards. If it becomes heavy, you need to contact us (you will be given contact numbers prior to discharge).

Are there any risks?

These are mostly the same as for surgical termination under general anaesthetic. There is a very small risk of having a reaction to the local anaesthetic.

–  –  –

What are the disadvantages?

Some women prefer not to be aware of the procedure. You may worry about coping with pain or anxiety.

Medical termination of pregnancy Will a medical termination be suitable for me?

Most women can have the treatment. However, you should not have this procedure if:

 You are not definitely pregnant  You have an ectopic pregnancy (pregnancy outside the womb)  Your are allergic to any of the ingredients in the Mifepristone or Misoprostol  You are taking any Corticosteroid treatments  You have any illness or you are taking any treatments that may stop your blood clotting  You have liver or kidney disease  You have a heart complaint, have an artificial valve fitted to your heart or you are receiving treatment for high blood pressure  You suffer from diabetes, asthma, bronchitis or high cholesterol.

If you are breast feeding you should stop for a least 14 days after the procedure.

Discuss any of these with the nurse at your clinic visit.

Hanover Women’s Healthcare Unit telephone number 01942 264962 / 3 (Monday to Friday 9:00am - 4:30pm). Our out of hour’s telephone number is for Swinley Ward (Wigan) 01942 822568.

Initial visit You will be seen at the termination of pregnancy referral clinic, where you will meet two nurses who specialise in sexual and reproductive health. You will firstly be seen by a Nurse Sonographer who will perform an internal vaginal ultrasound scan to confirm the number of weeks you are into your pregnancy, and to check that the pregnancy is within the womb. Another nurse will ask you for details about your medical history, if you are taking any tablets or other medications – these might be ones that are prescribed by a GP or bought over the counter at the pharmacy. It may help us if you bring with you details of any medications, for example packaging or repeat prescription forms.

–  –  –

1) You can opt to go home after the second course of medication to pass the pregnancy tissue but only if you are over the age of sixteen and under 9 weeks gestation. See the information below.

2) You can opt to stay in hospital to pass the pregnancy tissue. Your length of stay can be up to 8 hours. However, if you are less than sixteen years of age or over 9 weeks gestation this will be the only option given. See the information below.

You will be required to sign two consent forms with the nurse. One consent says that you wish to proceed with the medical termination of pregnancy. The other consent is needed to allow for the cremation of foetal tissue after the procedure. (This is discussed below and complies with the Trust policy).

Blood tests will also be taken to check your blood group and to see whether or not your blood count is low.

Please feel free to ask questions during your appointment.

At the end of your clinic appointment you will be given two dates to attend the ward to receive your medication for the procedure to terminate your pregnancy. Take all your normal medication on the day of your admission. No treatment will be given on this clinic visit.

Relatives are not permitted to stay with you on the day of the procedure but we do need a contact number for someone who will be able to collect you on discharge and be responsible for you for 24 hours after your discharge (unless you are under the age of 16).

If you opt to go home after the second dose of medication then you must have someone with you to drive you home and stay with you for the next 24 hours.

Risks for both options It is reassuring to know that this procedure is very safe. However, no procedure is

absolutely safe and it is important that you know what the risks are:

 Bleeding - will occur as this is normal after taking the medication.

 Blood transfusion - we will take blood at your clinic visit which the hospital laboratory will process in case you need to have blood urgently cross-matched for a blood transfusion (rare).



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