Bedford Centre

The leaflet is detailed below, or you can download the 'Manual Vacuum Aspiration (MVA) for Termination of Pregnancy' in PDF

Definition

Manual Vacuum Aspiration (MVA) is a method of termination of pregnancy using suction undertaken with the patient awake.  A narrow tube attached to a syringe is used to empty the womb using aspiration (gentle suction). Local anaesthetic is injected into the cervix (neck of the womb) to minimise discomfort.

This leaflet will help to answer some of your questions about having a manual vacuum aspiration (MVA). It describes the benefits, risks and alternatives, as well as what you can expect when you come to hospital.

If there is anything you do not understand or would like more information about, please ask a member of staff.

Why have an MVA?

MVA is offered to women in the following situations:

• When a medical termination of pregnancy is contraindicated or declined
• When a surgical termination is requested
• To avoid general anaesthetic
• The procedure can be performed up to 12 weeks gestation

Is MVA a new procedure?

MVA has been performed for more than 30 years. It offers an additional choice for women who wish to terminate a pregnancy. It is a safe procedure, with high success rates and good patient satisfaction.

What does a MVA involve?

You will have a speculum examination (similar to that at a smear test) by the doctor undertaking the procedure. The cervix will be cleaned with cold fluid and and the local anaesthetic injection performed. This is very similar to that provided by a dentist and although women worry about it, it works very quickly to reduce discomfort. The neck of the womb is gently stretched to allow the tube to be passed to remove the pregnancy tissue.

You will feel some discomfort during the procedure (similar to period pain). Entonox (‘gas and air’) will be available for you to use if you wish. If you feel pain, please let the nurse or doctor know. Additional local anaesthetic including use of a local anaesthetic gel may be possible, but if you find the procedure too uncomfortable it can be stopped, and the procedure can be done in theatre under sedation/general anaesthetic. Sometimes an ultrasound scan may be repeated to check that all of the pregnancy tissue has been removed.

How long will the MVA take?

The actual procedure takes about 15 minutes. It is important to arrive for your appointment on time.  You will stay in the department for a minimum of 30 minutes after the procedure.

What happens if I choose MVA?

You will be given two 200mcg Misoprostol tablets to insert into your vagina at home two hours before your MVA.  You should  insert the two Misoprostol tablets into the top of your vagina as high as you can place them; this can be done lying down or squatting. These tablets help to soften the cervix (neck of the womb) to reduce the risk of damage during the procedure. This indication is outside the product licence but common practice. Side effects include nausea, diarrhoea, cramping, bleeding. It is important that you are certain of your decision to proceed with the termination before the tablets are inserted. If you change your mind after insertion of the tablets, there is a risk of miscarriage or birth defects if the pregnancy continues.

Misoprostol can be delivered orally between the lip and the gum but tastes unpleasant and takes a long time to dissolve. This is the reason that we recommend vaginal delivery.

On the day of your MVA, we advise that you attend your appointment unaccompanied. If necessary- one support person may attend with you but they will be asked to remain in the waiting area for the duration of your procedure. Children are not permitted on the Bedford Centre. Please arrive on time and a clinician will see you to discuss the procedure and answer any last-minute questions. The procedure will take place in a different room. A nurse and healthcare assistant will be present to assist the doctor and support you throughout the procedure.

What happens afterwards?

We will monitor you for 30 minutes after the procedure. This includes reviewing vaginal bleeding and any pain you are having. You can leave the hospital once you feel well enough to go home.

You can expect some vaginal bleeding after the MVA; this usually settles within seven days.

If the bleeding becomes heavier than the end of a period (or you are concerned about the amount of bleeding) you will need to contact the Bedford Centre on 0151 708 9988 ext 4509 during working hours or the Gynaecology Emergency Department on 0151 702 4140 out of hours.

We recommend you use sanitary towels instead of tampons and do not have sexual intercourse until the bleeding has settled. This reduces the risk of infection. You may return to work when you feel able.

What are the options if I do not want MVA?

Other treatment options will be discussed with you by a nurse or doctor to help you decide.  These include:

• Medical management (using medication to end the pregnancy)
• Surgical management in theatre

How does MVA compare to other options?

Some women using medication to terminate the pregnancy, have to have a further procedure to manage tissue left behind. Studies comparing MVA to surgical evacuation under general anaesthetic have shown MVA to be just as effective; most women (more than 97 out of 100) having MVA will not need any further surgical treatment.

What are the possible complications of MVA?

MVA is safe, but like all procedures there is a small risk of complications. The risk of complications with an MVA is similar to a suction procedure under general anaesthetic, but without the potential complications caused by a general anaesthetic.

Complications related to the procedure are rare. They include heavy bleeding (haemorrhage), infection, the need for a repeat operation if not all the pregnancy tissue is removed (three in 100 women) and less commonly a perforation (tear) of the womb that may need repair (less than one in 1,000 women). If a perforation occurs, we may need to look inside your tummy to check whether there is bleeding, and if necessary, to repair the tear. This is done by a small cut on your tummy (abdomen) under general anaesthetic and insertion of a telescope (laparoscopy). 

The risk of infection is the same with surgical treatment (MVA or suction under general anaesthesia) and medical treatment options.

Help, support and further information

The team caring for you understand that this is likely to be an incredibly difficult time for  you and your partner, and we will do our best to support you and answer your questions.

Please contact us if you have any questions or concerns: Tel: 0151 708 9988 ext 1130 or please look at the patient information section on the Liverpool Women’s NHS hospital website.

If you are not coping emotionally, we would suggest that you contact your GP or Liverpool Bereavement Services on 0151 236 3932 so that counselling or support can be arranged.

The leaflet is detailed below, or you can download the 'Treatment at Home for Early Medical Abortion (Up To 9 Weeks + 6 Days -Tablet Method)' leaflet in PDF.

PLEASE READ THIS LEAFLET CAREFULLY AND KEEP IT THROUGHOUT YOUR TREATMENT AS IT CONTAINS IMPORTANT INFORMATION REGARDING YOUR PROCEDURE AND AFTERCARE

POINTS TO BE AWARE OF BEFORE YOU START THE PROCEDURE

It is important before you take the first tablet that you are certain of your decision to proceed with the abortion. IF YOU DECIDE TO CONTINUE WITH YOUR PREGNANCY OR NO LONGER REQUIRE THE MEDICATION- PLEASE DISCARD OF THIS IMMEDIATLEY VIA YOUR LOCAL PHARMACY OR THE BEDFORD CENTRE.

There are known risks to the fetus from the medication and therefore, we must recommend that once you have taken the tablet(s) that you continue with the abortion.

• It is recommended that you do not smoke or drink any alcohol once the procedure has commenced
• Due to the unpredictability of the procedure, we recommend you inform us of any travel plans arranged.
• If you are breastfeeding you may continue during the medical procedure as only small amounts of the drugs, Mifepristone and Misoprostol pass into the breast milk and are therefore not expected to cause adverse effects in the breastfed infant

EARLY MEDICAL ABORTION PROCEDURE

You have been sent both parts of the treatment to take at home. You will receive a text message from DPD courier service with a unique 4-digit PIN code. It is therefore important that you provide the Bedford Centre with the correct mobile telephone number. It is also important that you are at home on the day of delivery as the courier driver will require you to state the PIN number upon delivery. If you are not able to give this PIN number, the medication will not be delivered, and you will need to contact the Bedford Centre immediately to reschedule treatment. The medication can be delivered anytime between 9am and 6pm. Please read these instructions carefully and if you have any concerns or questions, please call the Bedford Centre on 0151 708 9988 ext 4509 prior to taking ANY of the tablets.

The treatment consists of two parts; the first part is a single tablet taken orally with water.  The second part will happen 48 hours (two days) after taking the first tablet. This will consist of four tablets to be taken vaginally or orally and a further two tablets to be taken 2 hours after this. 

First Part of your Treatment

You have been sent a single tablet called Mifepristone 200 mcg to swallow with water. If you vomit within 30 minutes of taking it, please contact the Bedford Centre as we will need to arrange sending out another tablet.

Following this tablet, you may experience some nausea and / or vomiting also bleeding and period type pain.

It is important to note that bleeding at this stage does not mean that you have passed the pregnancy therefore you should continue with the next stage of treatment as planned

If you have discomfort, you can take over the counter pain relief such as Paracetamol and Ibuprofen as per package directions

Second part of Treatment

You are advised to have a responsible adult stay with you at home when you take the Misoprostol 200 mcg tablets and to remain with you for the rest of the day and overnight.

You will have been given 6 tablets called Misoprostol to be taken at home 48hours after the First medication; they can be taken in the following way

• Option 1 this is preferred method as you will experience fewer side effects.  Place 4 of the Misoprostal tablets into the top of your vagina as high as you can place them. This can be done lying down or squatting. After two hours, repeat this process with the other two Misoprostal tablets.

 Or

• Option 2 taken by mouth. Place 2 tablets on each side of your mouth (4 tablets in total), between cheek and gum and allow the tablets to dissolve for 30 minutes.  If after 30 minutes they have not completely dissolved, swallow what is left with water. After two hours, repeat this process with the other two Misoprostal tablets.

What to expect after the second medication at home

•  You will experience vaginal bleeding which can be heavy with blood clots and this may be accompanied by passage of the pregnancy tissue

• Period type pain (cramps) usually 1-2 hours after taking the tablet. For any pain and discomfort you experience you can use Paracetamol and Ibuprofen. Please read the patient information leaflet with the packet and take as directed

• You may experience some nausea, vomiting, dizziness, possible diarrhoea or cold or hot flushes. These are known side effects from these tablets and will not stop the process from working

• For most people the procedure is likely to be completed within 4-6 hours of taking the Misoprostol, however it may take up to a few days.

We request that you contact the Bedford Centre for advice 7 days after taking the Misoprostol tablets if you have only had a slight blood loss without clots or you have not had any bleeding or you continue to have symptoms of pregnancy.

This may mean that the procedure has been unsuccessful.

KNOWN RISKS OF EARLY MEDICAL ABORTION

•  The risk of a failed procedure and continuing pregnancy (up to 1 in a 100 under 9 weeks, up to 3 in a 100 between 9 and 10 weeks)
• Excessive bleeding (haemorrhage) requiring blood transfusion,
• Retained pregnancy tissue requiring further treatment.
• Infection
• Undiagnosed ectopic pregnancy – this is rare
• Emotional / psychological distress following an abortion -If you are not coping, we would suggest that you contact your GP or Liverpool Bereavement Services on 0151 236 3932 so that counselling or support can be arranged.
• Risk of death is very rare

We give you this information regarding the risks not to alarm you, but we feel you would wish to know so that you can make an informed decision. More detailed statistics are in the consent form which will have been explained to you. 

FOLLOW UP INFORMATION

You will be given a pregnancy test which you should perform two weeks after you have taken the medication. It is very important that you follow this advice as this will determine whether the abortion has been successful.

Please only use the pregnancy test you are supplied with as they are different to the tests you can buy.

You must contact the Bedford Centre on 0151 708 9988 ext. 4509 if the pregnancy test is positive. We will arrange an appointment for you to be reviewed.

If you do not contact the Bedford Centre, we will assume that you have performed the home pregnancy test on the date requested and that it has shown a negative result

DISCHARGE ADVICE FOLLOWING EARLY MEDICAL ABORTION

1. As already discussed, you are advised to have a responsible adult with you, who is aware of the treatment and remain with you until the following morning.
2. You are advised not to travel long distances, especially by air, until you have performed a negative home pregnancy at 2 weeks post treatment. If you do decide to travel we strongly recommend you inform your travel insurance provider that you are undergoing a procedure.
3. Bleeding following the procedure is very individual. It can last for up to 3 weeks as a continuation of the procedure, this is not a period. It is not unusual for the bleeding to stop and start during this time. With this bleeding we advise you to use sanitary towels not tampons.
4. You are advised to maintain your normal hygiene routine, however, whilst you are bleeding when showering it is important that you do not apply the jet of water directly to the vagina (douching) as this may increase the risk of infection.
5. You are advised to avoid sexual intercourse until you have a negative pregnancy test Using condoms may help to reduce the risk of infection.
6. You can get pregnant before your next period if adequate contraception is not used.
7. Your next period should occur 4 – 6 weeks following the procedure; however, this can be affected by the method of contraception you are using. The bleeding on this period may be heavier than you are normally used to.
8. It is advisable that you limit any strenuous activity including prolonged sports activities until your bleeding has settled.

If you should develop any of the following, either contact the Gynaecology Emergency Department at the Liverpool Women’s Hospital 0151 702 4140 or contact your local Accident & Emergency Department:

• Heavy and continuous bleeding that soaks through 2 or more pads in an hour for a period of 2 hours.
• Severe repeated or continuous abdominal pains - if not eased with the tablets you have taken for pain relief.
• Violent shivering attacks / chills
• High temperature
• Offensive (smelly) vaginal discharge

If suitable, you may also be offered a 28-day supply of the oral contraceptive pill which will be sent out with the medication in the post. This pill is a progestogen only pill.

What is it?

• A daily pill containing a single hormone – progestogen (called Desogestrel).

How do I use it?

• Take one pill at the same time every day with no breaks.
• If started within 5 days of an abortion it is effective straight away. Otherwise, you will need to wait for 48 hours (2 days of pill taking).
• If you miss a pill, take it when you do remember and use condoms or do not have sex for the first 48 hours of correct pill taking.

Is it effective?

• With correct and consistent use, it is 99% effective.
• If the pill is not always used according to the instructions, it is around 91% effective.

Safety

• It is safe for most people to take the POP, there are very few reasons why someone cannot take the POP.

Periods

• Bleeding may become irregular, may stop completely, or may last a little longer.

Side effects 

• There are no serious side effects with the POP. You may get some side effects when you first start taking the POP, such as spotty skin, breast tenderness and headaches. These are likely to stop within a few months.

If you require any further advice regarding this method of abortion you can contact The Bedford Centre on 0151-708-9988 extension 1130 between 08.30 and 16.30hrs. Monday to Friday

During the procedure if you require out of hours advice for any of the above list or any other concerns the Gynaecology Emergency Department is open 24 hours a day on 0151-702-4140.

The leaflet is detailed below, or you can download the 'Early Medical Abortion commenced at LWH (up to 9 weeks + 6 days - tablet method)' leaflet in PDF.

PLEASE READ THIS LEAFLET CAREFULLY AND KEEP IT THROUGHOUT YOUR TREATMENT AS IT CONTAINS IMPORTANT INFORMATION REGARDING YOUR PROCEDURE AND AFTERCARE

POINTS TO BE AWARE OF BEFORE YOU START THE PROCEDURE

It is important before you take the first tablet that you are certain of your decision to proceed with the abortion.

There are known risks to the fetus from this medication and therefore, we must recommend that once you have taken the tablet(s) that you continue with the abortion.

• It is recommended that you do not smoke or drink any alcohol once the procedure has commenced
• Due to the unpredictability of the procedure, we recommend you inform us of any travel plans arranged.
• If you are breastfeeding you may continue during the medical procedure as only small amounts of the drugs, Mifepristone and Misoprostol pass into the breast milk and are therefore not expected to cause adverse effects in the breastfed infant

EARLY MEDICAL ABORTION PROCEDURE

First Part of your Treatment

You are advised to attend the Bedford Centre alone. If necessary- one support person may attend with you, however, you will be seen by the nurse alone. Children are not permitted on the department. You will be given a tablet called Mifepristone to swallow with water whilst in the clinic. If you vomit within 30 minutes of taking it contact the clinic as you will need to return for another tablet.

• Following this tablet you may experience some nausea and / or vomiting also bleeding and period type pain.
• It is important to note that bleeding at this stage does not mean that you have passed the pregnancy therefore you should continue with the next stage of treatment as planned
• If you have discomfort you can take over the counter pain relief such as Paracetamol and Ibuprofen as per package directions

Final part of Treatment at home

• You are advised to have a responsible adult stay with you at home when you take the Misoprostol tablets and to remain with you the rest of the day and overnight.

• You will be given 4 tablets called Misoprostol to be taken at home 48hours after the First medication and they can be taken in the following way

Option 1 - this is preferred method as you will experience fewer side effects.  Place 4 of the Misoprostol tablets into the top of your vagina as high as you can place them. This can be done lying down or squatting. After two hours, repeat this process with the other two Misoprostol tablets. 

Or

Option 2 - taken by mouth.  Place 2 tablets on each side of your mouth (4 tablets in total), between cheek and gum and allow the tablets to dissolve for 30 minutes.  If after 30 minutes they have not completely dissolved, swallow what is left with water. After two hours, repeat this process with the other two Misoprostol tablets.

What to expect after the final medication at home -

• You will experience vaginal bleeding which can be heavy with blood clots and this may be accompanied by passage of the pregnancy tissue.
• Period type (cramps) pain usually 1-2 hours after using the tablet. For any pain and discomfort, you experience you can use Paracetamol and Ibuprofen. Please read the patient information leaflet with the packet and take as directed 
• You may experience some nausea, vomiting, dizziness, possible diarrhoea or cold or hot flushes. These are known side effects from these tablets and will not stop the process tablet from working.
• For most people the procedure is likely to be completed within 4-6 hours of taking the Misoprostol, however it may take up to a few days.

We request that you contact the Bedford Centre for advice 7 days after taking the Misoprostol tablets if you have only had a slight blood loss without clots or you have not had any bleeding or you continue to have symptoms of pregnancy.

This may mean that the procedure has been unsuccessful.

KNOWN RISKS OF EARLY MEDICAL ABORTION

• The risk of a failed procedure and continuing pregnancy
• Excessive bleeding (haemorrhage) requiring blood transfusion,
• Retained pregnancy tissue requiring further treatment.
• Infection
• Undiagnosed ectopic pregnancy – this is rare
• Emotional / psychological distress following an abortion -If you are not coping, we would suggest that you contact your GP or Liverpool Bereavement Services on 0151 236 3932 so that counselling or support can be arranged.
• Risk of death is very rare.

We give you this information regarding the risks not to alarm you but we feel you would wish know so that you can make an informed decision. More detailed statistics are in the consent form you will have read and signed before starting the procedure.

FOLLOW UP INFORMATION

You will be given a pregnancy test which you should perform two weeks after you have taken the medication. It is very important that you follow this advice as this will determine whether the abortion has been successful.

Please only use the pregnancy test you are supplied with as they are different to the tests you can buy.

You must contact the Bedford Centre on 0151 708 9988 ext. 4509 if the pregnancy test is positive. We will arrange an appointment for you to be reviewed.

If you do not contact the Bedford Centre, we will assume that you have performed the home pregnancy test on the date requested and that it has shown a negative result

DISCHARGE ADVICE FOLLOWING EARLY MEDICAL ABORTION

1. As already discussed, you are advised to have a responsible adult, with you who is aware of the treatment and remain with you until the following morning.
2. You are advised not to travel long distances, especially by air, until you have performed a negative home pregnancy at 2 weeks post treatment. If you do decide to travel, we strongly recommend you inform your travel insurance provider that you are undergoing a procedure.
3. Bleeding following the procedure is very individual. It can last for up to 3 weeks as a continuation of the procedure, this is not a period. It is not unusual for the bleeding to stop and start during this time. With this bleeding we advise you to use sanitary towels not tampons.
4. You are advised to maintain your normal hygiene routine, however whilst you are bleeding when a showering it is important that you do not apply the jet of water directly to the vagina (douching) as this may increase the risk of infection.
5. You are advised to avoid sexual intercourse until you have a negative pregnancy test Using condoms may help to reduce the risk of infection.
6. You can get pregnant before your next period if adequate contraception is not used.
7. Your next period should occur 4 – 6 weeks following the procedure; however, this can be affected by the method of contraception you are using. The bleeding on this period may be heavier than you are normally used to.
8. It is advisable that you limit any strenuous activity including prolonged sports activities until your bleeding has settled.

If you should develop any of the following, either contact the Gynaecology Emergency Department at the Liverpool Women’s Hospital 0151 0151 702 4140 or contact your local Accident & Emergency Department:

• Heavy and continuous bleeding that soaks through 2 or more pads in an hour for a period of 2 hours.
• Severe repeated or continuous abdominal pains - if not eased with the tablets you have taken for pain relief.
• Violent shivering attacks / chills
• High temperature
• Offensive (smelly) vaginal discharge

If you require any further advice regarding this method of abortion you can contact

The Bedford Centre on 0151-708-9988 extension 4509 between 08.30 and 16.30hrs Monday to Friday.

During the procedure if you require out of hours advice for any of the above list or any other concerns, the Gynaecology Emergency Department is open 24 hours a day on 0151-702-4140.

 

 

The leaflet is detailed below, or you can download the 'Late Medical Termination of Pregnancy (9+1 to 16+6 weeks - tablet method)' leaflet in PDF.

PLEASE READ THIS LEAFLET CAREFULLY AND KEEP IT THROUGHOUT YOUR TREATMENT AS IT CONTAINS IMPORTANT INFORMATION REGARDING YOUR PROCEDURE AND AFTERCARE.

A Late Medical Termination of Pregnancy is available from ten weeks and up to sixteen weeks plus six days of pregnancy. If you choose and are found suitable for  this procedure, it will involve a further visit to the Bedford Centre for the administration of the first tablet and then, 48 hours later, admission to the Gynaecology Unit for the second medication where you will stay until the procedure is complete.

You will be asked to sign a consent form for the procedure and in doing so, you are showing that you have read, understood and accepted all the information provided.

Your confidentiality will be maintained in accordance with Trust policy, however there are certain circumstances where sharing of information with other health care professionals or organisations is required to protect an individual from harm. Wherever possible we will involve you with the sharing of your personal information.

THE LATE MEDICAL PROCEDURE

What is the procedure?

It is a course of tablets which helps to empty the uterus (womb) by causing bleeding. Afterwards the tablets help the uterus (womb) to return to normal. You will need to remain in hospital until the termination of pregnancy process is complete. This may require an overnight stay in hospital.

First Visit

We advise that you attend the Bedford Centre alone. If necessary- only one support person may attend with you, however, you will be seen by the nurse alone. Children are not permitted on the Bedford Centre.

On your first visit you will be given a tablet called Mifepristone to swallow with water. This drug works by blocking the action of the hormone progesterone which is needed to maintain the pregnancy. You may leave after taking the tablet however you may be advised by the nurse to remain for approximately half an hour if you wish to do so.

Following this tablet and before your next visit you may or may not experience some period type pains and some bleeding. It is also possible you may experience nausea and/or vomiting although this is unusual.  If you start to bleed at any time after taking the first tablet (Mifepristone) you must attend or contact the Liverpool Women’s Hospital Gynaecology Emergency Department on 0151 702 4140.

If you experience any pain or discomfort that you require pain killers for, you can use Paracetamol / Ibuprofen. If you are going to take Paracetamol / Ibuprofen at home, please read the patient information leaflet in the packet and take as directed. If you are worried about anything concerned with the procedure, there are contact telephone numbers at the end of this leaflet that you can ring for advice.

If your blood group is found to be Rhesus negative, you may require an Anti D injection. If Anti D is required you will be given an information leaflet explaining this and why Anti D is recommended.

Second Visit

You will be requested to attend the ward alone. We ask for your safety that you remain on the ward during your treatment. If you leave the ward against the advice of nursing or medical staff the Trust cannot accept responsibility for your health and welfare.

If possible please have something to eat prior to your admission. You will need to bring with you, toiletries including a towel, packs of press on sanitary towels, several pairs of briefs. Nightdress and any items required for a possible overnight stay. Hot drinks and meals are provided during your stay on the ward. It is important that you do not bring any valuables with you to the hospital. Please do not bring in any electrical equipment that needs to be plugged in.

You will be given tablets called Misoprostol which will need to be inserted into the top of your vagina. This can be done by yourself or a nurse. You will be asked to lie down for 30 minutes to allow the tablets to be absorbed. The tablets will cause the womb to contract to help expel the pregnancy.

Following the first dose of Misoprostol you will be given further doses of these tablets orally every three hours until you have passed the pregnancy. You will experience vaginal bleeding and some period type pains. Medication will be available for pain relief on request.

During your stay you may feel sick, vomit or possibly have diarrhoea, although it is unusual. These are known effects from the Misoprostol tablets you have been given and will not stop the tablets from working.  You will remain on the ward until the pregnancy has been passed and are well enough to be discharged. If you have not passed the pregnancy, you will be reviewed by a doctor, and this may involve an overnight stay and possible further medication.

If you still do not pass the pregnancy, we may give a rest from the tablets and recommence them the next day. There is a possibility that you will see the pregnancy.  Nursing staff will be available to support you throughout your admission.

Following the procedure, it may become evident that there is some pregnancy tissue remaining and this may require you to go to theatre. The procedure would be performed under general anaesthetic.

We advise you do not drive yourself home but for you to arrange for someone to escort you home and look after you that night, as you may feel unwell or have a heavy bleed. You will have had the opportunity to discuss your future contraception when you attended for your consultation. If you require further information / advice you can contact your GP, local Family Planning Clinic or The Bedford Centre.

Follow Up

You will be advised to do a low sensitivity pregnancy test at home two weeks after your procedure.

It is important that you contact The Bedford Centre on 0151 708 9988 ext. 1130 if the pregnancy test is positive. This is so we can make arrangements to see you in the clinic. If you do not contact the clinic we will assume that the test is negative.

POINTS TO BE AWARE OF BEFORE YOU START THE PROCEDURE

It is important before you take the first tablet that you are certain of your decision to proceed with the termination of pregnancy. There are known risks to the fetus from the medication and therefore, we must recommend that once you have taken the tablet(s) that you continue with the termination of pregnancy.

• The treatment you will be given involves taking two different types of tablet. The first is Mifepristone, followed by Misoprostol. Both of these drugs are widely available but their use in combination is outside their product licence. Whilst we are obliged to inform you of this, we should at the same time reassure you that there is much research and clinical experience of the use of these two drugs in this way.

• It is recommended that you do not smoke or drink any alcohol once the procedure has commenced.

• There is a possibility that you may see the pregnancy (fetus).

• Due to the unpredictability of the procedure we recommend you inform us of any travel plans arranged.

• Whilst you are in the hospital you will be asked to sign a consent form to allow the Trust to take responsibility for the communal cremation of your pregnancy loss. Alternative arrangements can be made, if you require further information please ask a member of staff.

• Breast feeding should be avoided during the procedure – please inform a member of staff for more advice.

RECOGNISED RISKS OF LATE MEDICAL TERMINATION OF PREGNANCY

• Blood transfusion – this is possible but not probable less than 1 in 1000 however, it does depend how much blood you lose during the procedure.

• Excessive bleeding (haemorrhage) 1 in 1000, if you feel that your bleeding is excessive you should seek urgent medical care from the Emergency Room at the Liverpool Women’s Hospital or your local Accident and Emergency Department.

• Retained pregnancy tissue requiring further treatment 1 in 100. You may experience irregular or continuous bleeding and/or abdominal pain. You will need to seek medical advice from your GP or the Emergency Room. If this occurs, treatment options will be discussed with you.

• Infection up to 1 in 10 – if you notice any abnormal, offensive discharge, general feeling of being unwell, high temperature / fever, you should contact your GP. If left untreated this can lead to a more severe infection known as pelvic inflammatory disease.

• There is a small risk of less than 1 in 1000 that your womb may become damaged during the procedure, including uterine rupture in pregnancy’s greater than 13 weeks. This may require a further procedure under anaesthetic and on very rare occasions may result in a hysterectomy. Women who have had previous caesarean section are more at risk and therefore are managed with reduced doses of Misoprostal.

• Emotional / psychological distress – as an individual, it is difficult to predict whether you will experience any emotional problems immediately after or in the future, following a termination of pregnancy. If you are not coping, we would suggest that you either contact your GP or Liverpool Bereavement Services on 0151 236 3932 so that counselling or support can be arranged.

• There is a small risk of less than 1 in 100 in the failure to end the pregnancy.

• Risk of death is very rare.

We give you this information regarding the risks not to alarm you but we feel you would wish to know so that you can make an informed decision.

CARE FOLLOWING LATE MEDICAL TERMINATION OF PREGNANCY

1. You must be accompanied home by a responsible adult, who will remain with you over night and who is aware of the treatment you have had.

2. Due to the nature of the procedure, we advise that you do not drive yourself home following your discharge from the ward (second visit).

3. You are advised not to travel long distances, especially by air, until you have performed your home pregnancy as advised following the procedure and are well. However, if you do decide to travel, we strongly recommend you inform your travel insurance company that you are undergoing a procedure.

4. It is advisable, once you have been discharged from the ward (second visit) that you do not undertake any strenuous activity i.e. lifting, carrying heavy loads and exercise such as sports activities until your bleeding has settled.

5. You may need some time off work. If you require any further information or have any concerns, please discuss with a member of the nursing team.

6. You are advised to have a bath/shower daily whilst you are bleeding (you do not need to add anything to the bath water). If having a shower it is important that you do not apply the jet of water directly to the vagina (douching) as this may increase the risk of infection.

7. You are advised to avoid sexual intercourse until your bleeding has stopped as you may be at risk of infection Using condoms may help to reduce the risk of infection. You can get pregnant before your next period if adequate contraception is not used.

8. Your next period should occur 4 – 6 weeks following the procedure; however this can be affected by the method of contraception you are using. The bleeding on this period may be heavier than you are normally used to.

9. Bleeding following the procedure is very individual. It can last for up to 3 weeks as a continuation of the procedure, this is not a period. It is not unusual for the bleeding to stop and start during this time. With this bleeding we advise you to use sanitary towels not tampons.

10. You may experience ‘period type’ pains (cramping) following your discharge from the ward and pain relief can be taken as advised (second visit).

If you should develop any of the following, contact the Emergency Room at the Liverpool Women’s Hospital or contact your local Accident & Emergency Department:

• Heavy and continuous bleeding that soaks through 2 or more pads in an hour for a period of 2 hours. However if at any time you feel unwell please contact the Gynaecology Emergency Department at the Liverpool Women’s Hospital for advice
• Severe repeated or continuous abdominal pains - if not eased with the tablets you have taken for pain relief.
• Violent shivering attacks / chills
• High temperature
• Offensive (smelly) vaginal discharge

During the procedure if you require advice for any of the above list or any other concerns the Gynaecology Emergency Department is open 24 hours a day on 0151-702-4140.

If you require any further advice regarding this method of abortion you can contact The Bedford Clinic on 0151-708-9988 extension 1130 between 08.30 and 16.30h.

The leaflet is detailed below, or you can download the 'Surgical Termination of Pregnancy' leaflet in PDF.

PLEASE READ THIS LEAFLET CAREFULLY AND KEEP IT THROUGHOUT YOUR TREATMENT AS IT CONTAINS IMPORTANT INFORMATION REGARDING YOUR PROCEDURE AND AFTERCARE.

A surgical abortion is available from the eighth week to the twelfth week of pregnancy. If you choose and are found suitable for this method, it will involve a day-case admission after your initial consultation.

You will be asked to sign a consent form for this procedure and by doing so you are showing that you have read, understood, and accepted all the information provided.

Your confidentiality will be maintained in accordance with Trust policy, however there are certain circumstances where sharing of information with other health care professionals or organisations is required to protect an individual from harm. Wherever possible we will involve you with the sharing of your personal information.

THE SURGICAL PROCEDURE

The procedure takes approximately ten minutes and is carried out under either general anaesthetic or deep sedation, which means you will be asleep or very deeply sedated. The surgeon gently dilates (stretches open) the passage through the cervix (entrance to the womb) until it is wide enough to allow the pregnancy in the womb to be removed with a suction tube.

POINTS TO BE AWARE OF BEFORE YOU START THE PROCEDURE

• To avoid cancellation of your operation it is extremely important that you do not have anything to eat (including chewing gum), drink (this includes water) or smoke from the time stated on your appointment letter
• Please remove any body piercings, e.g., belly piercing / tongue
• Please ensure that you have a bath or shower on the day of your admission before you arrive at The Bedford Centre
• Please remove all make up / false nails / nail varnish
• You will need to bring with you the following
  • Nightdress / pyjamas
  • Dressing Gown
  • Slippers
  • Packs of press on sanitary towels
  • Several pairs of briefs
  • Any prescribed medicines including Inhalers
• Please do not bring any valuables and any electrical equipment that needs to be plug in.
• If you are breast feeding, please inform a member of staff for more advice.
• Whilst you are in the hospital you will need to sign a consent form to allow the Trust to take responsibility for the communal cremation of your pregnancy loss. Alternative arrangements can be made, if you require further information, please ask a member of staff.

DAY OF ADMISSION

You will need to attend The Bedford Centre at the time given to you on your appointment letter. It is important that you arrive on time as if you do not, we may not be able to perform the procedure.

On arrival at the centre, you will be shown to a waiting room by a member of staff. You will then be seen by one of the nurses who will go through the admissions procedure which will involve asking you a few questions and completing a theatre check list. The nurse will discuss with you what will happen throughout your stay.

You will be given tablets called Misoprostol to soften and dilate the cervix (neck of the womb) to help reduce the risk of damage during the procedure. The use of these tablets to help reduce the risk of damage is outside the product licence. Whilst we are obliged to inform you of this, we should at the same time reassure you that there is much research and clinical experience of use of this drug in this way. These 2 tablets need to be inserted into the top of your vagina this can be done by yourself or a nurse if you wish. Side effects of these tablets are uncommon however you may experience sickness, cramping, bleeding and diarrhoea. It is important that you are certain of your decision to proceed with the termination before the tablets are inserted. If you change your mind after insertion of the tablets you may go on to miscarry the pregnancy, however if miscarriage doesn’t occur and the pregnancy continues there are known risks to the foetus (birth defects)

In preparation for your operation, you will be asked to remove all your clothes including your underwear and put on the theatre gown provided.

We advise you to attend alone as unfortunately the ward cannot accommodate visitors.

This will also help our aim of maintaining your privacy and dignity and that of other patients on the ward. Children are not permitted on the Bedford Centre. You will also be seen by the surgeon and the anaesthetist on the day of the procedure, and we ask for this reason and for your safety that you remain on the ward during your admission.

If you leave the ward against the advice of nursing or medical staff the Trust cannot accept responsibility for your health and welfare.

When it is time for your operation, you will be accompanied to theatre reception by one of the nurses or healthcare assistants.

When you arrive in theatre reception your details will be checked, and you will then be taken through into the anaesthetic room on a theatre trolley. It is here that you will be given a general anaesthetic. Once you are asleep you will be taken through to the theatre. During your operation you will be given an antibiotic in the form of a rectal suppository.  After the procedure has been performed you will wake up in the recovery area. When the recovery nurse is satisfied that you are well, a nurse from the ward will collect you and take you back with a theatre porter to the ward on a theatre trolley. You will be away from the ward approximately 30 minutes. On return to the Gynaecology Ward the nurse will assist you back into bed and check your blood loss. If you have any pain the nurse will give you pain relief .You will be allowed a drink of water. After resting, you will be given something to eat and drink.

If your blood group is found to be Rhesus negative, you may require an Anti D injection. If Anti D is required, you will be given an information leaflet explaining this and why Anti D is recommended.

You will remain on the Gynaecology Ward for at least two hours. Nursing staff will be available to support you throughout the day. A nurse will complete a discharge assessment with you prior to you leaving the ward ensuring that you are fit to go home. You should arrange for someone to escort you home and look after you that night, as you may feel unwell or have a heavy bleed.

RECOGNISED RISKS OF SURGICAL ABORTION

•  Abnormal bleeding – there are various causes; if the bleeding lasts for longer than 2 weeks or if you feel that your bleeding is abnormal you should contact your GP. This bleeding may be treated by your GP; however, it sometimes requires further intervention which may need to be carried out in the hospital.
• Excessive bleeding (haemorrhage) 1 in 1000, if you feel that your bleeding is excessive you should seek urgent medical care from the Emergency Room at the Liverpool Women’s Hospital or your local Accident and Emergency Department.
• Retained pregnancy tissue requiring further treatment 1 in 100. You may experience irregular or continuous bleeding and / or abdominal pain. You will need to seek medical advice from your GP or the Emergency Room. If this occurs, treatment options will be discussed with you.
• Infection up to 1 in 10 – If you notice any abnormal, offensive discharge, general feeling of being unwell, high temperature / fever, you should contact your GP. If left untreated this can lead to a more severe infection known as pelvic inflammatory disease which may affect your future fertility
• Slightly higher risk of premature birth with subsequent pregnancies following an abortion, this risk increases with the number of abortions.
• Damage to the womb up to 4 in 1000 can occur during the operation.
• Damage to the cervix (entrance to the womb) is less than 1 in 100 can occur during the operation
• Damage to bowel, bladder, or serious damage to cervix (entrance to the womb) - very rare
• The risk of a failed procedure and a continuing pregnancy is less than 1 in 100; therefore, it is extremely important that you keep any follow up arrangements given to you before you leave the ward.
• Emotional / psychological distress – as an individual it is difficult to predict whether you will experience any emotional problems immediately after or in the future following an abortion. If you feel that you are not coping, we suggest you contact your GP or Liverpool Bereavement Services on 0151 236 3932 so that counselling or support can be arranged.
• Previous uterine (womb) and / or cervical (neck of womb) surgery (e.g. Caesarian section or loop biopsy of cervix) or pre-existing medical conditions may increase the risk of complications during the procedure.
• Risk of death is very rare

There are other procedures that may become necessary during the operation

• Blood transfusion – this is possible but not probable less than 1 in 1000, however this does depend on how much blood you lose during the procedure.
• Repair of a cervical tear – a tear in the cervix (entrance to the womb) may occur during the procedure.
• Laparoscopy (keyhole surgery) – a small camera is inserted through a small incision to allow the surgeon to inspect the abdominal organs.
• Laparotomy – an incision is made through the abdominal wall to allow the surgeon to inspect the abdominal cavity and organs.
• Repair of damage to cervix, uterus (womb), bladder, bowel, or blood vessels
• Hysterectomy (removal of the womb) is possible but is rare

The risk of serious complications increases if a further procedure is required to be performed other than the termination of pregnancy.

Risk associated with General Anaesthetic – you will have the opportunity to discuss any concerns with an anaesthetist. Further information regarding the risks of anaesthetics can be found in the ‘You and your anaesthetic’ leaflet which can be located on the Royal College of Anaesthetists (RCOA) website – www.youranaesthetic.info

We give you this information regarding the risks not to alarm you, but we feel you would want to know so that you can make an informed decision.

CARE FOLLOWING THE SURGICAL PROCEDURE

1. You must be accompanied home by a responsible adult who is aware of the treatment you have had and will remain with you for 24 hours. During this time, it is important that the person who is looking after you can always gain access to you e.g., do not lock the bathroom door.
2. It is important that you do not drink alcohol, take illegal substances or drugs, which have not been prescribed for you by a doctor, operate machinery (including power tools, boiling kettles, fires etc.) or make any important decisions for 24 hours after having a general anaesthetic.
3. It is a legal requirement that you do not drive for 24 hours after a general anaesthetic.
4. You are advised not to travel long distances, especially by air, until you have performed your home pregnancy as advised following the procedure and are well. However, if you do decide to travel, we strongly recommend you inform your travel insurance company that you are undergoing a procedure.
5. Following your operation, it is advisable that you do not undertake any strenuous activity i.e., lifting, carrying heavy loads and exercise such as sports activities until your bleeding has settled.
6. You are advised to have a bath / shower daily whilst you are bleeding (you do not need to add anything to the bath water). If having a shower, it is important that you do not apply the jet of water directly to the vagina (douching) as this may increase the risk of infection.
7. You are advised to avoid sexual intercourse whilst you are bleeding as this may increase the risk of infection, however using condoms may help to reduce this risk. You need to be aware that you can get pregnant before your next period if adequate contraception is not used.
8. Your next period should occur 4-6 weeks following the operation however, this can be affected by the method of conception you are using. The bleeding on this period may be heavier than you are normally used to.
9. Blood loss following the operation can be expected up to 7 days. The amount can vary, and it is not unusual for it to stop and start. This is not a period. With this bleeding we advise you to use sanitary towels.
10. You may experience ‘period type’ pains (cramping) as an individual this can be anywhere from 24 hours up to 1 week. You can use Paracetamol / Ibuprofen for pain relief as directed on the patient information leaflet in the packet. Do not exceed the stated dose in 24 hours.
11. You will be advised on discharge regarding follow up arrangements.

• You will be asked to do a low sensitivity pregnancy test at home 2 weeks after your operation.

It is important that you contact The Bedford Centre on 0151 708 9988 x 1130 if the pregnancy test is positive.  This is so we can arrange to see you in the clinic to confirm that your operation has been successful. If you do not contact the clinic, we will assume that the test is negative.

or

• You may be asked to return to the centre for your follow up.

12. If you should develop any of the following, contact the Gynaecology Emergency Department at the Liverpool Women’s Hospital or contact your local Accident & Emergency Department:

• Heavy and continuous bleeding that soaks through 2 or more pads in an hour for a period of 2 hours. However, if at any time you feel unwell, please contact the Gynaecology Emergency Department at the Liverpool Women’s Hospital for advice.
• Severe repeated or continuous abdominal pains - if not eased with the tablets you have taken for pain relief.
• Violent shivering attacks / chills
• High temperature
• Offensive (smelly) vaginal discharge

If you require advice for any of the above list the Gynaecology Emergency Department is open 24 hours a day on 0151-702-4140.

If you require any further advice on your procedure, you can contact The Bedford Centre on 0151-708-9988 ext. 1130 between 08.30 and 16.00hrs