Frequently Asked Questions

The first appointment is at The Chelsea and Westminster Hospital. This first appointment will be a consultation with the doctor to discuss your pregnancy, as well as an ultrasound scan, blood tests if you haven’t already had them. As there are a number of different issues to address it may take some time so expect to spend about one hour at the clinic.

It is important you bring, if it has been given to you, the Certificate A or ‘blue form’. The procedure cannot take place without this document for legal reasons.

The Doctor

They will talk to you about this pregnancy and ensure you wish to proceed with an abortion. They will take a 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.

The radiologist

This is the professional who performs the ultrasound scan so we can date the pregnancy. 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.

The nurse

Blood tests are taken for iron levels, blood group and blood variations such as sickle cell disease. Other tests are performed as necessary.

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

  • Under 7 weeks pregnant: only a medical termination of pregnancy (MTOP) is available at this early stage
  • Between 7 and 9 weeks pregnant: you can choose between a medical termination of pregnancy (MTOP) or surgical termination of pregnancy (STOP
  • Between 9 and 16 weeks pregnant: the only method available is the surgical method using suction
  • Over 16 weeks pregnant: you may be suitable for a late medical termination of pregnancy using tablets or surgery.

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:

  • Have allergies to mifepristone or misoprostol
  • Take steroids
  • Have any problems with your blood clotting / Take anti-coagulants
  • Are over 9 weeks pregnant
  • Severe asthma not controlled by medication
  • Liver or kidney disease

This is a safe procedure which is effective and has much less risk than having a baby. Medical terminations are safer than a surgical termination of pregnancy as there is no need for a general anaesthetic and no need to introduce instruments into the womb. The procedure is 97 to 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.

  • 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%

This will involve two visits, at Chelsea and Westminster Hospital. It involves taking a tablet by mouth (mifepristone) on one day then returning two days later for vaginal tablets (misoprostol) and possibly further tablets by mouth.

The mifepristone tablet [abortion pill] works by blocking the action the action of progesterone, the hormone needed to maintain a pregnancy. It is used with misoprostol, which is administered vaginally to induce an abortion.

You may choose to have an early medical termination if you are less than nine weeks. This will be confirmed by an ultrasound scan.

However, this method may not be suitable for you if you:

  • Have allergies to mifepristone or misoprostol
  • Take steroids
  • Have any problems with your blood clotting
  • Take anti-coagulants
  • Have severe asthma/ kidney or liver disease
  • Allergic reactions to mifepristone or misoprostol

You will be seen by the doctor who will give you the mifepristone tablet to swallow with water and answer any questions you may have about the procedure.

Please allow up to half an hour for this appointment. Between the medications, you can live a normal life at home or at work. You may feel no different to normal but you may have some bleeding or period type pains.

  • IF YOU HAVE ANY DOUBTS ABOUT YOUR TERMINATION, PLEASE TELL US DURING THIS VISIT.
  • YOUR TERMINATION CAN BE DELAYED AND FURTHER COUNSELLING ARRANGED.
  • IF YOU HAVE ANY DOUBTS ABOUT HAVING THE TERMINATION, YOU SHOULD NOT TAKE THE MIFEPRISTONE TABLET.

You may experience:

  • Crampy, period type pains
  • Nausea/ vomiting
  • Very occasionally you may start bleeding before your next visit to hospital. There is a small possibility of passing part or the entire pregnancy after taking the first medication.

If you vomit within 2 hours of taking the tablet, you may need another. Please come back to Outpatients 2 straight away.

If you experience crampy pains, you must only take tablets containing paracetamol and codeine type medications. Please do not take painkillers containing aspirin or ibuprofen (Eg. Nurofen) or similar drugs. Check with the doctor that the painkillers you have at home are suitable to take at this time. If you experience heavy bleeding please phone your doctor or report to casualty if concerned or mention this on your next visit. (Heavy bleeding may be more than three pads soaked in an hour or any amount that causes distress.)

You will be seen at Chelsea and Westminster 2 days after you have taken the mefipristone tablet. A nurse or doctor will administer tablets of misoprostol (cytotec) vaginally, or you can do it yourself.

If you do it yourself, you will be given some tablets of misoprostol, which will need to be inserted into your vagina or in some cases may be taken by mouth. If you are familiar with using tampons you may be able to insert the tablets with a tampon. This medication causes contractions which help your body pass the pregnancy. These can be painful but pain relief is available.

If you are over 7 weeks pregnant, you may be given two more tablets to swallow to help things along. Pains will usually start after a few hours.

The products of pregnancy should pass over the next few hours. If they haven’t been passed completely by this time, it is likely they will over the next 24 hours. We recommend you have someone to stay with you over this time. If you are concerned, please ring your designated doctor.

You will experience:

  • Period type pain
  • Bleeding
  • As pain is a very individual experience, it is important that you discuss how you are feeling with your named nurse who can then give you appropriate pain relief.
  • You will need to stay indoors for 6-8 hours after taking the abortion tablets. The pregnancy should be passed during this time.
  • If your blood group is rhesus negative you may need an anti D injection.
  • You should arrange for a friend or relative over 18 to stay with you overnight. Antibiotics (doxycycline) can be taken from the evening of the second part of the procedure. You will also be given pain killers and antibiotics to take at home.
  • You will be asked to do a pregnancy test three weeks after the procedure to ensure you are no longer pregnant. Some patients may be booked for a repeat scan two - three weeks after the termination if this is positive to ensure the pregnancy is not ongoing (less than 1-2% chance).
  • If you experience heavy bleeding and/or severe pain phone your contact or report to Accident and Emergency and you may be referred to the emergency gynaecologists on call for further assessment. (Heavy bleeding may be more than three to four pads soaked in an hour or any amount that causes distress.)
  • You can telephone the doctor whom you are under as necessary.
A surgical abortion or termination is performed by suction where no cutting is involved. It is called surgical because it takes place in an operating theatre. For you this will be at the Treatment Centre at Chelsea and Westminster Hospital. A suction termination of pregnancy (STOP) is performed under general anaesthetic which means you will be asleep during the procedure. A suction abortion involves one visit to the hospital. You may receive a tablet/s inserted into the vagina to relax and soften the neck of the womb an hour or two before the operation. When you are asleep a thin tube is passed through the neck of the womb and the contents carefully removed by suction. You may have a coil or contraceptive injection inserted under the anaesthetic if you have consented to this. While you are asleep, you will be given a painkiller that will be effective when you wake up. The whole procedure takes only a few minutes.

Surgical termination is most suitable for you if:

  • Have allergies to mifepristone or misoprostol
  • Take steroids
  • Have any problems with your blood clotting
  • Take anti-coagulants
  • Have severe asthma/ kidney or liver disease
  • Allergic reactions to mifepristone or misoprostol

Surgical termination may be unsuitable for you if:

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

This is a safe procedure which is effective. The most common complication is an infection in the uterus which occurs to between 2 and 5 women out of 100. All women having a termination are given a course of antibiotics to take afterwards. If you suffer an increase in bleeding, pelvic pain, significant 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 clinic or A&E as you may need further antibiotics.

It is possible for the operation to be unsuccessful and the pregnancy to continue in 1 in 1000 cases. 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 the 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 repaired 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 anaesthetic itself.

Surgical termination may be unsuitable for you if:

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

To prepare for the operation you must not eat or drink for 6 hours prior to the operation. If you are due to have an afternoon operation this means you should not eat or drink after 8am. These restrictions include sweets, chewing gum and water. It is important you follow these instructions as your operation may be cancelled if you do not.

  • Please bath or shower on the morning of your operation and do not wear make up, nail varnish, nail extensions, metal jewellery including body piercings.
  • Please bring a dressing gown, slippers and toothbrush and toothpaste. Please bring your own sanitary towels.
  • Please do not bring valuables as there are no facilities for storage and the Trust cannot accept responsibility for any loss. There are lockable lockers where you can leave a few items.

Please report to Chelsea Wing, 4th Floor of Chelsea and Westminster Hospital at 12.00pm (as directed).

If you are unable to attend for ANY reason please ring us on the direct line 07708 323 025. If you have any questions including if you are ill whether you should cancel your operation, please call on the number above.

A registered nurse will be responsible for your care throughout your stay in Chelsea Wing and the Treatment Centre. If you have any questions or concerns you should direct them to her/him.

The named nurse will direct you to an area to change and indicate where the toilets are. Before the operation you will see (a number of people including) a nurse, anaesthetist and surgeon. You will:

  • Be asked questions about your health and previous operations
  • Have your pulse and blood pressure taken
  • Be asked to remove any jewellery and be given an identity bracelet and special cotton gown to wear
  • Be asked to remove contact lenses

Immediately after the surgical termination you are taken to recovery. A nurse will be with you. You may feel drowsy, sick and sore. If you do please inform the nurse as they may be able to give you some medication. When you are awake and your pulse and blood pressure are stable you will be moved to a waiting room to rest. The nurse will then discuss with you when you are ready to go when your escort as arrived. You will be given pain killers and antibiotics to take home.

If you need any contraception or a sick note please let the nurse or doctor know BEFORE the operation.

An adult will need to take you home in a car or taxi. You may feel the effects of the anaesthetic for up to 24 hours and therefore should not:

  • drive a car or bicycle
  • operate machinery
  • drink alcohol or take sleeping tablets
  • make important decisions or sign any legal documents

We advise you to rest the night of your operation and do not go to work the day after the operation.

Most women bleed for up to a week or two after a surgical termination. As the cervix (neck of the womb) has been open it is best not to use tampons or have sexual intercourse for two weeks as there is an increased risk of infection.

It is difficult to predict how women will feel emotionally after the termination, for some women they may feel very sad for others a sense of relief. If you have any feelings of desperation please contact your GP or 0207 935 8633 and we will be able to arrange counselling help for you.

You will require someone over 18 to escort you home and we advise you do not travel on public transport. They must come to the Chelsea Wing at around 5 to 7 pm, although we cannot be specific about the time as it depends on how you react to the anaesthetic and operation. Occasionally it may be necessary to admit people to the ward overnight. Please bring a book or magazine or something to occupy your time.

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 doctor or the contacts in this leaflet and they will call you back if they are not immediately available.

PainYou may experience period-type pains after the termination. You may take paracetamol, medications like diclofenac (50mg up to 3 times daily) or Co-codamol medication you have been given (2 tablets every 4 to 6 hours, maximum 8 in one day) if you experience this. Paracetomol and Cocodamol cannot be taken together but Diclofenac and EITHER paracetomol OR Cocodamol can.

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 Accident and Emergency or the contact numbers given to you.

Retained tissue

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.

There is no evidence to suggest that a termination of pregnancy affects your future fertility. However if you develop an infection that is not treated quickly this may affect fertility and therefore it is important that you complete your antibiotics and seek help if you have any signs of infection from your GP, the clinic that referred you or A&E. You can get pregnant again very quickly after a termination therefore you must start using contraception immediately and condoms with a new partner.

It is safe to have a bath but 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. You may be asked to return to the clinic in two to three weeks after the procedure for repeat ultrasound scan to ensure all pregnancy tissue has been expelled and the uterus is empty. Usually this is not necessary and a pregnancy test will be adequate assurance the process is complete.

Please ring Mr Stafford’s secretary on: 07708 323 025

Chelsea and Westminster Hospital NHS Foundation Trust
369 Fulham Road
London
SW10 9NH

Gynaecology Outpatients
First Floor Lift band B

Treatment Centre
Ground Floor

Chelsea Wing
4th Floor Lift bank D

Private Outpatients (Westminster Wing)
4th Floor Lift Bank D

Chelsea & Westminster Healthcare NHS Trust
www.chelwest.nhs.uk

NHS Direct
www.nhsdirect.nhs.uk

 

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Our Specialist Services

Medical Abortion

Abortion carried out by medicine rather than surgery.

Surgical Abortion

The procedure is done with general anesthesia and oral pain-relieving medications.

STD Consultation

Diagnosis and treatment of early pregnancy problems including abortion, sexually transmitted infections (STIs).

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