Pregnancy Advisory Clinic

Please call 020 8321 5008 if you have any queries or need to rearrange your appointment.

This clinic visit is for consultation only. The termination will be performed after a thorough discussion with you about different methods. This leaflet will explain the options available to you.

All information is confidential but please inform us if you do not wish your GP to be informed of your appointment. We would not inform your GP routinely.

What happens at the clinic?

All appointments will be at the West Middlesex University Hospital. This appointment will involve an ultrasound scan, blood tests and consultation with a nurse and a doctor to discuss this pregnancy. As there are a number of different issues to address it may take some time so expect to spend 2–3 hours at the clinic. You may be able to have the termination of pregnancy on the same day depending on the method chosen.

Who will I see?

Administrator: The administrator will check your details and direct you to the appropriate professionals.
Sonographer: This professional performs the ultrasound scan so we can date the pregnancy and check it is developing normally. This is important as the type of termination available to you will depend on the gestation of the pregnancy (number of weeks). The pregnancy may have miscarried and alternative arrangements may be made. On rare occasions the pregnancy may not be in the womb (ectopic pregnancy) and further tests may need to be performed.
Nurse/healthcare assistant: This professional takes your blood. Blood tests are taken for iron levels, blood group and blood variations such as sickle cell disease. Other tests are performed as necessary.
Counsellor: You will be seen alone and have the opportunity to discuss your reasons for choosing a termination.
Nurse: The nurse will see you to answer any questions you have. They can discuss the different methods of termination of pregnancy and help you decide which is best for you. They will discuss some health issues that are important for the procedure. They will also discuss your future contraceptive needs that can be started at the time of, or shortly after, the procedure. You will be asked to take your own vaginal swab—this is collected from everyone to test for chlamydia and gonorrhoea infection.
Doctor: The doctor will talk to you about this pregnancy and ensure you wish to proceed with an abortion. They will take your medical history and then discuss the options available to you. The risks and benefits of the treatments will be explained and then you will be asked to sign a consent form for the procedure you have chosen to show you understand.

What types of termination are there?

This depends on the number of weeks pregnant you are on the day of your procedure. Pregnancy is dated from the first day of your last period and/or scan dates.

Under 7 weeks pregnant: Medical termination of pregnancy (MTOP) is the advised method, although you have the option of surgical termination of pregnancy under local anaesthetic (manual vacuum aspiration)
Between 7 and 9 weeks pregnant: You can choose between a medical termination of pregnancy (MTOP) or a surgical termination of pregnancy (STOP) under local or general anaesthetic, although the former is advised
Between 9 and 14 weeks pregnant: The only method available is the surgical method using suction
Between 14 and 18 weeks pregnant: You would be referred to Chelsea and Westminster Hospital
Over 18 weeks pregnant: You may be suitable for a late medical termination using tablets or surgical procedure and will be referred to the BPAS for specialist care.

If you wish to have a coil for contraception, you may wish to consider a surgical TOP, as this can be fitted during the procedure.

Post termination

It is safe to have a bath but it may be better to have a shower initially after the procedure. You should only use sanitary pads, not tampons after the termination, and avoid sex until the bleeding stops.

Contraception

It is important to consider a long acting method of contraception such as an injection, implant, intrauterine device (coil or hormonal coil). The nurse or doctor will be able to advise you and there is written information available at the clinic. These can be adminstiered during your time with us.

Why might I choose a medical termination?

Medical termination is most suitable for you if:

You are early in the pregnancy and would need to wait for a few weeks for a surgical termination
You don’t want or should not have a general anaesthetic
You wish to avoid the risks of surgical termination

Medical termination may be unsuitable for you if:

You have allergies to Mifepristone or Misoprostol
Take steroids
Have any problems with your blood clotting/take anti-coagulants
Are over 9 weeks pregnant
You have severe asthma not controlled by medication
You have liver or kidney disease

What risks are associated with a medical termination?

This is a safe procedure which is effective and has much less risk than having a baby.

Medical terminations are safer than surgical terminations of pregnancy as there is no need for a general anaesthetic and no need to introduce instruments into the womb. They are 97–99% effective. The risk of infection is smaller after a medical termination. All women having a termination are given a course of antibiotics to take afterwards.

Rare complications:

Excessive vaginal bleeding
Incomplete abortion, where some pregnancy tissue is left in the uterus and may require a general anaesthetic and operation to remove them
Ongoing pregnancy but this risk is less than 1%

Why might I choose a surgical termination?

Surgical termination is most suitable for you if:

You are more than 9 weeks pregnant
You want to get the procedure done today under local anaesthetic (you will be awake) but don’t have the risk of general anaesthetic
You cannot come to 2 separate appointments at the hospital
You would rather not be awake during the termination (general anaesthetic)

Surgical termination may be unsuitable for you if:

You do not want or cannot have a local or general anaesthetic
You cannot arrange for an adult to escort you home

What risks are associated with a surgical termination?

This is a safe procedure which is effective. The most common complication is an infection in the uterus which occurs in 2–5 in 100 women. All women having a termination are given a course of antibiotics to take afterwards. If you suffer an increase in bleeding, pelvic pain, significantly smelly vaginal discharge, a fever or any combination of these, you may have an infection. In this situation we recommend you contact your GP or go to A&E as you may require further antibiotics.

It is possible for the operation to be unsuccessful and the pregnancy to continue—this occurs in approximately 1 in 1,000 operations. It is more likely the earlier the pregnancy is. This may necessitate either a medical termination or a repeat surgical procedure.

Infrequently, not all the products of pregnancy are removed which can cause heavy bleeding which may also require a further similar operation.

Very rarely a small hole can be made in the womb that may require a further operation (either keyhole or open surgery). This may be reparied at the time or at a secondary operation, particularly if there is suspected bowel or bladder damage or internal bleeding. This may occur in up to 1 in 300 cases.

All operations have a small risk associated with the general anaesthetic itself.

After the termination

Bleeding

You can expect to bleed for 2–3 weeks following the termination. Initially the bleeding can be heavy and you may pass clots. If you have any concerns about the bleeding, please contact your GP, A&E or the clinic at West Middlesex University Hospital during working hours on 020 8321 5008/5005 to leave a message and a nurse or doctor will call you back if necessary.

Pain

You may experience period-type pain after the termination. You may take paracetamol, medications like diclofenac or ibuprofen or codeine type medications if you experience this.

Infection

As with all procedures there is a risk of infection. All women are given antibiotics to take home. The main symptoms of an infection after the procedure are an offensive smelling vaginal discharge and abdominal pain. If you have any concerns you should contact either your GP or A&E.

Contraception

This would have been discussed in clinic with the doctor or family planning nurse.

Retained products of pregnancy

Some women do not expel all the pregnancy tissue following the procedure. If this is the case, then you will need to have an operation performed to remove the tissue that is left behind. This will be performed under general anaesthetic.

Further information

Contact information

Gynaecology Outpatients
1st Floor, Twickenham House

T: 020 8321 5008/5005

Contributors

Liz Alden George Vasilopoulos