Non Surgical Terminations
Information on the Medical Termination of Pregnancy
The Abortion Pill
Below is some information to help inform you about the nature and effects of the medicines used in a medical abortion. This information is intended to help educate you, so you can make an informed decision.
The Abortion Pill is a synthetic ‘anti-progesterone’ medication. By preventing the effects of progesterone in the uterus, this medicine interferes with implantation and placental development, resulting in the fetus not growing. The abortion pill also softens the cervix and makes the uterus more likely to expel the pregnancy, especially if used in combination with another medication, which is a "prostaglandin like" medication.
Used alone The Abortion Pill is not very effective. In order to increase the likelihood of success, The Abortion Pill is used in combination with another medication, called prostaglandin which causes the uterus to contract and the cervix to soften, allowing the embryo to be pushed out of the uterus. The combined regime of The Abortion Pill and then another drug used 24 hours later has been found to be up to 95-98% effective, if used in pregnancies equal to or less than 7 weeks gestation. In other words, it will fail to achieve a miscarriage in 2-5 out of every 100 patients. Above 7 weeks gestation the likelihood of success decreases to 91 %. The pain and bleeding are also found to be heavier so, its use is limited to pregnancies less than 9 weeks gestation.
What do I need to know about the process of a medical abortion?
In order to have a medical abortion the doctor will need to check a few things:
- Blood tests: you will need to have your blood group, blood count and pregnancy hormone level checked.
- An ultrasound will need to be performed to ensure that the pregnancy is in the uterus and is not an ‘ectopic ‘ or ‘tubal’ pregnancy. This will also confirm how pregnant you are so that no mistakes are made. Our centre prefers to avoid the use of the medical abortion regime for pregnancies over 8 weeks due to the reduced chance of success and greater likelihood for heavier bleeding and pain during the abortion process.
- Certainty of decision; counseling will need to be done during your initial consultation to ensure that you understand the necessary procedure, that you are aware of the possible risks involved and have all the necessary information. It is essential that you are certain of your decision prior to undergoing the treatment due to risk of fetal abnormality if the treatment fails (Studies were done that showed a 9 % chance of fetal abnormality in those pregnancies continued after a failed medical abortion.)
- If you elect to undergo a medical abortion swabs will be taken to assess for the presence of harmful bacteria that might cause an infection during or after the abortion process. Antibiotics are usually prescribed.
- Patient care plan; it is important that you are able to communicate and have a thought out plan, if problems arise during your miscarriage process. More than one in ten patients who start out having a medical abortion might need to undergo surgery for issues such as bleeding, remaining tissue and incomplete abortion so this must be taken into consideration. The doctor will need to know if you have a phone and have someone who could drive you if you need to attend our clinic or the hospital for emergency care. You should have all the necessary phone numbers, including the closest hospital at hand. This will be provided by our clinic and discussed during the initial consultation.
Do I have to go for more than one appointment?
It is essential that you and your doctor are able to assess if the treatment has been successful. As mentioned there is a 2 % failure rate and high chance of fetal abnormality if the pregnancy is continued (9 %). We will organize a follow up blood test to be taken 10 days after the medical abortion to check that your pregnancy hormone levels have dropped successfully. This will be done prior to your 2 week check up appointment with us. At this ‘two week’ consultation other issues such as remaining tissue, prolonged bleeding and infection can be assessed by examination and pelvic ultrasound.If you live a long distance away from our clinic then we can coordinate this consultation with your local doctor, if they are agreeable.
Can any doctor prescribe this medication?
The Abortion Pill can only be dispensed by doctors licensed to do so, once the doctor is happy that this is a safe option for you. In Australia the doctors who prescribe this medication must be experienced in termination of pregnancy and have authority to prescribe this medicine (given by the Therapeutic Goods Administration.) The TGA is allowing some doctors to import this medication as part of a controlled study of its use. Currently we have an application underway with the TGA for approvalso until this is granted we cannot use this medication.
Comparison of Medical and Surgical Abortion
Medical abortion performed under 9 weeks gestation |
Surgical abortion performed under 13 weeks gestation |
Your chance of still being pregnant after treatment is 1 in 50 if performed before 7 weeks gestation (98% effective). This decreases to 1 in 10 if performed after 7 weeks (91% effective) |
Your chances of being pregnant if the surgery is performed after 6 weeks gestation is less than one in 2500 pregnancies according to our statistics. (99.9 % effective.) |
Is best performed for early pregnancies once the pregnancy sac can be seen on ultrasound (5 – 6 weeks.) It can be used for pregnancies up to 9 weeks but is most effective if 7 weeks gestation or less. |
Is best performed from 6 weeks gestation, once the pregnancy sac can be seen on ultrasound up until 13 weeks at our clinic. Other Clinics will perform the operation for later pregnancies so please call for more information. |
Anaesthesia is not required unless you need surgery. It is important to remember that some women might need to undergo surgery for reasons such as: incomplete miscarriage/ remaining tissue (5%), failed abortion (2 %), very heavy bleeding (4 %) i.e. approximately 1 out of every 15 patients
Avoiding anaesthesia and surgery can be a good option if you have a history of anaesthetic complications, difficult past surgery, multiple prior surgical abortions and obesity. |
Anaesthesia required. Intravenous sedation is used so that you are asleep /sedated during the surgery. The level of sedation can be discussed with the anaethetist. Sedation is given to minimize discomfort during the removal of the pregnancy. The percentage of women needing repeat surgery for failed surgical abortions is 0.01 %, remaining tissue is 0.5 %, for very heavy bleeding 0.05 % i.e. approximately one – two out of every thousand patients. |
Miscarriage is usually completed at home within 12 hours of taking the second medication however might take days or even weeks to complete. |
The procedure takes place in theatre and takes about 15 minutes. You will need to visit the clinic for a total of 3 hours and need someone to drive you home. |
Side effects of the medications are generally greater including:
- Nausea(50 %)
- Vomiting (15 %)
- Diarrhea (15 %)
- Hot flushes/fever (15 %)
- Faintness (10 %)
- Pain. Women who undergo a medical abortion are more likely to experience pain, especially when the abortion occurs after 7 weeks gestation.
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Nausea and vomiting can occur after your surgery and are treated before you leave the clinic. Similarly post- operative pain is treated so that you should only have mild to moderate period pain when you leave the clinic. |
Bleeding lasts longer for a medical abortion, on average 9 days.
Some patients might bleed for up to one month after the tablets are taken.
The bleeding can be heavier than with a surgical abortion (4 % women experience heavy bleeding.)
The later the abortion is performed the greater the chance of heavy bleeding. |
Average bleeding with a surgical abortion is 4 days.
Bleeding rarely lasts for more than 2 weeks
Studies show heavy bleeding occurs in 0.05 – 1 % of women after a surgical abortion. Surgery performed after 10 weeks gestation has a greater potential for bleeding. |
Fertility. Where no further surgery is required there is no risk to future fertility except by delaying pregnancy i.e. Women over 37 years of age have a sudden and dramatic decrease in natural fertility.
In cases where surgery is avoided there is no risk of uterine perforation. |
Studies show that having one to two operations does not decrease fertility. We have no studies to know if this changes if further surgery is required. It is important to remember that the same surgery is needed often for incomplete miscarriages occurring naturally.
The risk of uterine perforation is approximately one in 1000 patients. |
Requires a minimum of two visits to the clinic two weeks apart. |
One visit is needed lasting 3-4 hours, with someone to drive you home. |
Very few studies can be found looking at the rate of infection following a medical versus surgical abortion but the evidence we have suggests the rates are similar (0.92 % or approx. 1 %) |
The risk of infection following a surgical abortion has been found to be 1.2 %. |
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