Abortion

From the first day of your last period. For women with a menstrual cycle of average length, that day is usually about two weeks before conception, which explains why pregnancies are said to last 40 weeks.

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Depending on the length of the pregnancy, a small pregnancy sac may be visible.

Most of the time women can see blood and tissue in their sanitary pad or in the toilet. The (very small) embryo is usually passed within this blood and tissue, and so often goes unnoticed.

At 8-9 weeks pregnant, you might see a sac in the blood and it may be possible to see the embryo (at this stage the embryo is about 2.5 cm) this can be distressing. It is best to flush the toilet and throw sanitary pads away as usual.

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Early medical abortion - up to 9 weeks

An early stage abortion is possible without an internal procedure. Three clinic appointments are needed.

You will be asked to take two different medicines 36-48 hours apart.

• On your first visit you will be given an abortion pill to block the hormone that makes the lining of the womb suitable for the fertilised egg. A few women will have mild cramps and a little bleeding at this stage. If you have heavy bleeding or significant pain, you should contact the hospital or clinic where you had your appointment. If it is out-of-hours, you should go to the nearest A&E department.
• Two days later, you will be given the second medicine and within four to six hours, your womb will expel the pregnancy. This part of the process can be painful, but you can take a painkiller. Bleeding may be heavy and you may notice some clotting. Some women can find this distressing so you should talk to your clinician in advance about what to expect.

Some services have facilities for this process to happen at the clinic. Some women prefer to go through this process at home. This can be your choice.

Vacuum aspiration or suction termination - 7 to 15 weeks

This method uses gentle suction to remove the foetus from the womb. The procedure usually takes 5 to 10 minutes and can be carried out in a day surgery unit under either sedation local anaesthetic or general anaesthetic. If you have sedation or general anaesthetic you will need to have someone with you after the procedure and you will not be able to drive home yourself.

You will usually be able to go home the same day.

• your cervix (womb entrance) will be widened. This may be made easier by an oral or vaginal tablet a few hours before that softens your cervix
• a small, plastic suction tube connected to a pump will then be inserted into your womb and used to remove the foetus and surrounding tissue.

Following the procedure, you will usually experience vaginal bleeding for up to 21 days.

In most cases, the bleeding will be quite heavy for two to three days before settling down. You may experience cramps for which you can take painkillers at home.

Surgical dilation and evacuation (D&E) - 15 to 24 weeks

This is a surgical procedure carried out under general anaesthetic. It usually takes 10-20 minutes and, if you are healthy and there are no complications, you may be able to return home the same day.

Your cervix will be gently stretched and dilated. Forceps and a suction tube will be used to remove the foetus and tissue within the womb.

You may experience vaginal bleeding for up to 21 days afterwards.

Late medical abortion - 9 to 20 weeks

This method uses the same medication as an early medical abortion but will take longer and more than one dose of medication may be needed.

You will usually be able to return home on the same day. However, sometimes an overnight stay in hospital may be required.

In a small number of cases (less than 1 in 20), the placenta or afterbirth does not pass. In this case, you may need to have a small operation under a general anaesthetic to remove the placenta.

Late abortion - 20 to 24 weeks

There are two options and both require an overnight stay in hospital and are carried out under general anaesthetic.

1. Surgical two-stage abortion:

• stage one stops the heartbeat of the foetus and softens the cervix
• stage two (carried out the next day) involves removing the foetus and surrounding tissue.

2. Medically induced abortion (similar to a late natural miscarriage)

• medicine is injected into your womb, making it contract strongly (as in labour). Contractions can last 6-12 hours. You will remain awake during this stage and will be given medicines to help control the pain if needed
• your cervix will be gently stretched and dilated and forceps and a suction tube will be used to remove the foetus and tissue within the womb.

All of these procedures can feel invasive and distressing, so you may want to consider having someone nearby to support you when you leave hospital. It’s also important to talk to your clinician about what to expect during and after any procedure.

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An ultrasound scan uses high frequency sound waves to create an image of part of the inside of the body. Ultrasound scans can give a more accurate estimation of the length of the pregnancy than counting the weeks from the last period.

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The Abortion Act 1967 covers England, Scotland and Wales but not Northern Ireland.

It states, abortions can usually only be carried out during the first 24 weeks of pregnancy as long as:

• abortions must be carried out in a hospital or a specialist licensed clinic
• two doctors must agree that an abortion would cause less damage to a woman's physical or mental health than continuing with the pregnancy. (Likely to be your GP and the doctor at the clinic where the abortion will take place.)

The law states an abortion may be carried out after 24 weeks in rare cases where:

• it is necessary to save the woman's life
• it would prevent grave permanent injury to the physical or mental health of the pregnant woman
• there is substantial risk that the child would be born with serious physical or mental disabilities.

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This is usually picked up during the routine ultrasound screening tests that are part of antenatal care.

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Yes, the abortion will usually go on your health record if you have been referred by your GP. If you self refer, the clinic may encourage you to allow them to inform your GP but this is not automatically done as it is a confidential service.

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No, your fertility should return to normal after an uncomplicated abortion. In fact, women can be experienced an increase in their fertility soon after a termination so it is important to start contraception straight away to prevent another pregnancy from happening.

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