MEDICAL TERMINATION OF PREGNANCY
(THE ABORTION PILL)
Used alone, Abortion Pills are not very effective. In order to increase the likelihood of success, the Abortion Pill is used in combination with another medication; this is a prostaglandin-like medication 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 taking the Abortion Pill and the other drug used 48 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.
Seven weeks gestation decreases the likelihood of success to 91 %. The pain and bleeding are also found to be heavier. Hence, in Australia, a woman must be less than nine weeks pregnant to have a medical termination of pregnancy.
WHAT DO I NEED TO KNOW ABOUT THE PROCESS OF A MEDICAL ABORTION?
In order to have a medical termination of pregnancy, 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. Please see your local doctor to organise these tests. Alternatively if this is not possible, please call us and we will email you the request form.
- 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. We will do this on your first appointment.
- Certainty of decision: counselling 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 about the medical termination of pregnancy. It is essential that you are certain of your decision prior to undergoing the treatment due to the risk of foetal abnormality if the treatment fails (Studies were done that showed a 9 % chance of foetal 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. The medical termination of pregnancy requires precautions to prevent infections which are why 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 termination of pregnancy might need to undergo surgery for issues such as bleeding, remaining tissue and incomplete abortion; all of 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 whether the treatment has been successful. As mentioned there is a 2 % failure rate and high chance of foetal 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, we can coordinate this consultation with your local doctor with their consent.
CAN ANY DOCTOR PRESCRIBE THIS MEDICATION?
Abortion Pills can only be dispensed by doctors licensed to do so, once the doctor is happy that this is a safe option for you. In Melbourne and Victoria, doctors must be experienced in the medical termination of pregnancy in order to have the authority to prescribe this medication (given by the Therapeutic Goods Administration.)
Our Doctor has been granted a licence with approval to prescribe this medication for pregnancies under 9 weeks (63 days) and for patients who are medically suitable for this treatment.
COMPARISON OF MEDICAL AND SURGICAL ABORTION
COMPARISON OF MEDICAL AND SURGICAL ABORTION
- Medical abortion performed under 9 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)
- 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.
- 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 surgeries, multiple prior surgical abortions and obesity.
- Miscarriage is usually completed at home within 12 hours of taking the second medication. However, this might take days or even weeks to complete.
- Side effects of the medications are generally greater including: Nausea (50 %) Vomiting (15 %) Diarrhoea (15 %) Hot flushes/fever (15 %) Faintness (10 %) Pain. Women who undergo a medical termination of pregnancy are more likely to experience pain, especially when the abortion occurs after 7 weeks gestation.
- Bleeding lasts longer for a medical termination of pregnancy than surgical: on average, for 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.
- 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.
- Medical termination of pregnancy requires a minimum of two visits to the clinic two weeks apart.
- 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 %)
- Surgical abortions are performed under 13 weeks gestation
- 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 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 required. Intravenous sedation is used so that you are asleep /sedated during the surgery. The level of sedation can be discussed with the anaesthetist. 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.
- 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.
- Nausea and vomiting can occur after your surgery; you are treated for this 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.
- 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.
- 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.
- One visit lasting 3-4 hours is needed. You’ll need to bring someone to drive you home after.
- The risk of infection following a surgical abortion has been found to be 1.2 %.
Please note: A referral form is not needed.
For more information on the medical termination of pregnancy in Melbourne or to make an appointment, you can call 03 97992817. You can also click here to make an online appointment.