How can pregnancy be terminated

You can access this service through your GP or family planning clinic. If you want to avoid the NHS or have your choice of where you go, you can go directly to an abortion provider but you will have to pay. The tests you have will depend on your own health.

Women with no health problems may not need any tests. Sometimes blood tests may be necessary. These might be to check that you are not anaemic or that your blood clots normally when you bleed. The clinic will need to check your blood group. This is to see whether you are rhesus positive or negative. Rhesus-negative women need to have an injection called anti-D after the abortion. This is to prevent an immune reaction happening in any future pregnancies, which may make that baby anaemic. Some women may need an ultrasound scan to see how many weeks pregnant they are.

This is usually only necessary if you are very unsure of your last period and have no idea how pregnant you are. The clinic may check if you have certain germs bacteria in the vagina and womb.

If they are present, you may be more likely to have an infection after the procedure. To prevent this, a course of antibiotics is given. There are usually two different antibiotics - metronidazole and doxycycline or azithromycin. They may be given during the procedure, if you have a surgical abortion. Immediately afterwards, you will usually feel crampy tummy abdominal pain, like period pain.

You can take simple painkillers such as the ones you might use for period pain - for example, ibuprofen. The pain usually settles in a few hours. After the abortion it is normal to have some vaginal bleeding.

This should be no worse than a period and should stop after a week or so. While you are bleeding you should not use tampons or have sex. This is because you have an increased risk of getting an infection at this time. Be aware that you can become pregnant again immediately after an abortion. This is why discussing contraception with your doctor at the clinic is a good idea.

Infection may make you feel hot and sweaty and a bit sick. There may also be pain in your lower abdomen. The discharge from your vagina might become smelly. If you feel you may have an infection you should talk with your doctor.

You may feel absolutely fine the next day and be able to go back to work. You may feel quite emotional. This is normal and usually settles as your body goes back to normal. If you continue to feel upset it may help to talk with a counsellor about it. Your doctor or your clinic should be able to arrange this. Best practice in comprehensive abortion care ; Royal College of Obstetricians and Gynaecologists, Induced Abortion Worldwide ; Guttmacher Institute, My girlfriend took 6 at home pregnancy tests - 4 were positive.

The nurse couldn't give us an exact diagnosis - only her own opinion on whether or not my girlfriend Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Egton Medical Information Systems Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy.

Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions. In this article What are my choices?

Women treated through sublingual route were found to have similar rates of successful abortion compared to those treated through vaginal route RR 0. There may be little to no difference in successful abortion rates among women treated through buccal route compared to those treated through sublingual RR 0.

Safety and satisfaction rates of tested routes appears to be similar Table S4, Additional file 3. One study compared 7 different misoprostol only regimens [ 14 ] Table 2.

None of the study arms was more effective than the other. In addition, we were not able to compare the safety outcomes of these regimens Table S5, Additional file 3. Women treated with medical method showed higher rates of ongoing pregnancy than those receiving surgical management RR 6.

There was little to no difference in rates of successful abortion between the two methods RR 1. There was a lower rate of serious adverse events and complications among women who received medical compared with those who received surgical management RR 0.

The certainty of evidence is very low for all reported outcomes Table S6, Additional file 3. In this review we identified 33 trials conducted across different settings with a total of 22, participants. We compared effectiveness, safety and acceptability of different combination and misoprostol only regimens. Acceptability was not explicitly reported; thus, we used satisfaction, which was reported in 25 of the included studies, as a proxy indicator.

The results of this review demonstrate that the majority of the studies compared different combination and misoprostol alone regimens in terms of dosing, route and frequency of administration. This reflects the fact that mifepristone has replaced older medications, such as methotrexate and gemeprost, when used in combination with misoprostol.

A combined regimen of mifepristone and misoprostol was found to be more effective in terms of lower rates of ongoing pregnancy and higher rates of successful abortion compared to the misoprostol alone regimen [ 6 , 7 , 8 ]. There have been multiple studies that focus on the combination regimen, comparing various misoprostol doses and routes and the interval between mifepristone and misoprostol. Review of studies that compared different dosing interval between mifepristone and misoprostol in combined regimen showed inconclusive results.

Individual studies showed a h interval to be more effective compared to either 8- or h intervals [ 5 , 9 , 10 , 32 , 40 ]. However, we were not able to replicate these findings in the pooled analysis. We found similar rates of effectiveness between h and h intervals.

In addition, the safety profile and satisfaction rates were not significantly different across intervals. Comparing 8-h interval to h and h intervals showed that a shorter interval of misoprostol administration did not significantly compromise effectiveness [ 11 , 12 ]. Furthermore, a h interval was no more effective than concurrent administration. Our results align with existing evidence that demonstrates that concurrent administration can lead to higher satisfaction rates [ 5 , 25 , 38 ], while also impacting the number of visits required and time needed to complete the procedure [ 5 ].

Nonetheless, satisfaction rate was not consistently reported across studies. Thus, further research is needed to assess the impact of dosing interval on this outcome and how it relates to the acceptability of the procedure to women. When comparing studies to determine optimal routes of misoprostol in combined mifepristone misoprostol regimen, there were mixed results.

There is moderate certainty of evidence that oral misoprostol is significantly less effective than vaginal misoprostol [ 23 , 33 , 34 ]. Similarly, oral route was less effective than buccal route low certainty of evidence [ 41 ]. However, individual studies show that oral administration of misoprostol in the combined regimen leads to better overall satisfaction [ 18 , 23 , 33 , 34 ]. Buccal route was as effective as sublingual and vaginal route and there was no significant difference between sublingual and vaginal routes [ 18 , 28 , 31 ].

Given the findings of the non-significant differences between the routes, women should be given the full range options factoring in their satisfaction towards a particular treatment regimen. A review of one study with 7 different arms comparing misoprostol only regimens failed to demonstrate superiority of one regimen over the others.

This potentially means that the compared regimens are equally effective and at this time no conclusions can be made without additional studies evaluating misoprostol only regimens.

This is important in order to address the needs of those who cannot afford or access mifepristone [ 14 ]. Compared to surgical method, medical management had significantly higher rates of ongoing pregnancy. Lower rates of serious adverse events and complications were observed with medical compared to surgical methods [ 29 ]. However, interpretation of this finding requires caution as it was based on only one trial and certainty of evidence was very low.

One study comparing oral versus vaginal misoprostol reported one woman in the vaginal arm who died from a systemic Clostridium sordellii infection [ 35 ]. However, in general, the rates of serious adverse events reported in our review are very low, thus we cannot draw definitive conclusions related to adverse events.

This review has several strengths. We used a comprehensive and replicable search strategy to identify relevant articles. In addition, the included studies were conducted across different settings. We employed the GRADE system that can assist health care providers, program managers and policy makers to design and implement best practice recommendations and guidelines. Limitations of this review include the inclusion of only RCTs and using satisfaction as a proxy for acceptability.

Specifically, inclusion of observational studies could be more informative about client satisfaction and acceptability of treatment regimens.

We were not able to demonstrate statistically significant differences for various dosing intervals and routes of misoprostol administration in combination or in misoprostol alone regimens. There are only a limited number of studies for some of the comparisons medical vs. In addition, some of the included studies have a high risk of performance and detection bias. Thus, we recommend future research studies to consider blinding of outcome assessor as it is feasible to blind the individual who is assessing the success of the abortion whether by history, physical exam or ultrasound and this in turn can improve the quality of data.

The combined regimen of mifepristone and misoprostol was more effective than the misoprostol alone regimen. The datasets supporting the conclusions of this article are included within the article and its additional files. Karim SMM. Use of prostaglandin E 2 in the management of missed abortion, missed labour, and hydatidiform mole. Br Med J. Contraception ;16 4 — Abortion is a safe procedure.

Abortions are safest, and happen with less pain and bleeding, when carried out as early as possible in pregnancy. Most women will not experience any problems, but there is a small risk of complications, such as:.

If complications do occur, you may need further treatment, including surgery. Having an abortion will not affect your chances of becoming pregnant again and having normal pregnancies in the future. You may be able to get pregnant immediately after an abortion.

You should use contraception if you do not want to get pregnant. Read more about the risks of abortion. Page last reviewed: 24 April Next review due: 24 April An abortion is a procedure to end a pregnancy. Follow-up procedures are not required after a surgical abortion unless complications related to the abortion begin to occur.

We are dedicated to providing expert, affordable pregnancy termination. We believe every woman deserves to be treated with respect and dignity regardless of any life circumstances.

When a woman decides to have an abortion, it is a very personal decision. We recognize that having an abortion may be a difficult choice, and we provide the support and information women need to help make a decision that is right for their individual situation.

Once a woman has made the decision to have an abortion, many questions follow. The most common ones that we hear are:. These questions are normal. We want to make sure that women are fully knowledgeable about the abortion procedure that she chooses and the costs associated with it. We also strive to be honest and supportive when it comes to the cost of our services. Some insurance plans cover abortions, but many do not. For this reason, we work with each woman to determine the best payment option for her situation.

If you have questions about early abortions or would like to set up a consultation, please contact us:. Early Abortion First Trimester Early abortion at a glance An early abortion is the termination of a pregnancy during the first trimester the first 3 months of pregnancy. Early abortions can be accomplished with medication or surgery.