Medical termination of pregnancy

Medical abortion is intended for all women, but especially for those whose ultrasound examination at the Loote Ultrahelikeskus reveals that the embryo has died or has a congenital malformation that is unsuitable for life.

Abortion at a woman's request is a difficult decision with both emotional and psychological consequences. If you consider terminating your pregnancy, make sure you understand what it is and the possible side effects, complications, and alternatives.

What is medical termination of pregnancy?

Medical abortion is the removal of an embryo from the uterine cavity, not by surgery but by administering drugs. The Loote Ultrahelikeskus uses a combination of the drugs mifepristone and misoprostol to terminate a pregnancy. The combination of these drugs is safer than surgical abortion under anaesthesia.

At what age of gestation can a pregnancy be terminated with medication?

Medicinal abortion can be performed at the woman's own request if it has lasted less than 9 weeks (up to and including 8 weeks and 6 days).

How effective is abortion with medication?

The effectiveness of medical abortion is 95%. Thus, in 5% of cases, medical abortion ends with surgical cleaning of the uterine cavity in a hospital.

Where does an abortion occur?

The medication is administered at the Loote Ultrahelikeskus, but the abortion takes place at the patient's home.

Who benefits mainly from medical abortion?

who want to become pregnant in the future;
who want to terminate a pregnancy in their own home;
who do not wish to have a surgical termination of pregnancy under general anaesthesia;
who want to terminate a pregnancy at a small gestational age;
who want anonymity when terminating a pregnancy;
who need the support of their family in the event of an abortion;
who have uterine myoma or uterine malformations;
who is severely overweight;
who have had previous cervical surgeries.

Who is not suitable for medical abortion?

whose pregnancy is more than 9 weeks;
who are allergic to misoprostol or mifepristone;
who have a suspected ectopic pregnancy;
who have an intrauterine device;
who have congenital porphyria;
who have acute or chronic adrenal insufficiency;
who are taking long-term hormone therapy with corticosteroids;
who have significant coagulation disorders (eg von Willebrand's disease);
who have decompensated hypertension or coronary heart disease;
who have frequent seizure syndrome;
with severe anaemia (haemoglobin less than 100 g / l);
who do not have the opportunity to undergo a post-abortion check-up.

Procedures before an abortion.

Before terminating a pregnancy, the gynaecologist will perform an ultrasound to check the size and viability of the fetus and whether the pregnancy is in the uterine cavity. Your gynaecologist will take tests for infections and cytology of your cervix. The midwife/nurse will take a blood test from you and introduce it and then give you to sign the "Patient confirmations and consents regarding medical termination of pregnancy".

A gynaecologist planning to terminate a pregnancy must be informed:

your state of health;
all diseases suffered and present;
medicines used;
allergy to medicines.

The following tests are required to terminate a pregnancy:

venous blood: haemoglobin, rhesus factor and blood group with anti-erythrocyte antibodies, HIV and syphilis;
from the cervix: chlamydia, gonorrhoea, and cervical cytology.

How is medical termination of pregnancy performed?

First appointment with a gynecologist

On your first doctor's visit, you will be given the opportunity to take 1 tablet of Mifegyne (200 mg misoprostol) orally.

Taking the tablet is not dependent on the meal. There may be subtle abdominal pain or bleeding after taking the tablet, but there is also a possibility of having no disturbing signs. You can usually continue your daily activities and go back to work.
Second gynecologist's appointment

On a second doctor's visit, your gynaecologist will put, with your permission, 2 Cytotec tablets inside the vagina and will also give you to take in 2 Cytotec tablets (800 μg of misoprostol). Your doctor will put 1 Diclofenac suppository in your rectum for prophylaxis of abdominal pain and give you 2 Cytotec tablets (400 μg misoprostol) and 1 Cerucal tablet (10 mg metoclopramide) to administrate at home.

After the administration of Cytotec, pregnancy is terminated, in most women, within 4-6 hours, within 24 hours in 90% of women. If there is no vaginal bleeding within 4 hours after your doctor's visit, take additional 2 Cytotec tablets under your tongue. Usually, with additional administration of Cytotec, pregnancy will be terminated. In case this should not happen, you will come to the gynaecologist's appointment the next day at the previously agreed time.

It is advisable to not plan out-of-home activities for this day since the bleeding and pain can cause discomfort and require staying near the toilet.

Medicinal termination of pregnancy can be compared with the spontaneous termination process of pregnancy, which produces painful uterine contractions and blood transience through the vagina. The occurrence of convulsive lower abdominal pains for a few hours to a few days is normal. Over-the-counter oral ibuprofen 400-800 mg may be used during and after medicinal abortion. If the latter does not help, 2 tablets of paracetamol (1 g in total) can be added to the regimen. Do not take painkillers more than 3-4 times a day.

After an abortion, blood extrusion has more blood compared to normal menstruation and lasts longer, but mostly does not affect blood haemoglobin levels. Bloodshed will be higher the longer the pregnancy has lasted. Blood shedding is most intense within 3-6 hours after the administration of misoprostol. After the termination of pregnancy, blood-shedding (which is not menstruation) lasts an average of 2 weeks in a decreasing manner, but in some individual cases can last up to 45 days.

Fever and chills may occur within 1-2 hours after the administration of misoprostol. Approximately every other patient can experience nausea and one in three vomiting. In case of severe nausea, you can take the 1 Cerucal tablet that your gynaecologist has given to you.

After the administration of misoprostol, one in four women experiences mild and spontaneous transient diarrhoea, which, as a rule, does not require treatment. Transient headache, fainting and drowsiness may occur.
Third gynecologist's appointment

On the third doctor's visit, the gynaecologist checks with a transvaginal ultrasound scan to see whether the abortion has occurred fully.

If the pregnancy is terminated before the 9th week of pregnancy, rhesus-negative women will not develop anti-rhesus antibodies, which could cause rhesus conflict in the developing fetus during subsequent pregnancies. Therefore, anti-D immunoprophylaxis with Rhesonativ does not need to be performed.

You are entitled to a certificate of incapacity for work for the termination of pregnancy and the day after that.

What are the possible complications of medical termination of pregnancy and indications for emergency hospitalisation?

Abortion in your own home is generally a safe procedure. However, the following possible complications must be taken into account:

Bleeding

Incidence < 1: 1000. Excretion of blood clots, full soaking of two large hygienic bonds for two consecutive hours, fainting and a strong feeling of weakness indicate increased blood loss, which requires emergency help.

If blood excretion from the vagina has lasted for more than 45 days after a medicinal abortion or blood excretion continues after the next menstruation, it is necessary to go to an emergency health facility.
Continuation of pregnancy

Incidence < 1:100. The likelihood of continuation of pregnancy increases with the pregnancy lasted more than 9 weeks. The continuation of pregnancy is confirmed by the gynaecologist during the third visit, in which case the procedure of abortion must be repeated: for this purpose, misoprostol will be administered repeatedly or the patient is referred to the hospital for surgical termination of pregnancy.
Incomplete abortion

Incidence 1:20. Incomplete miscarriage is detected by a gynaecologist during a third medical visit. In case of incomplete miscarriage, in the absence of abundant blood-shedding and signs of inflammation, monitoring tactics can be applied. In many cases, the uterine cavity is self-draining. The recommended time for control is after menstruation. Due to incomplete abortion, surgical intervention or repeated administration of misoprostol may be required.
Inflammation of the pelvic organs

Incidence < 1:100. Inflammation may be indicated by fever, lower abdominal pain, chills and/or purulent secretion from the vagina. If, after the administration of misoprostol, the fever lasts more than 4 hours or develops in the following days after administration of misoprostol, it may be an indication of inflammation. The occurrence of convulsive pains can be normal for a few hours to two days. Pain with increased bleeding and/or fever requires further investigation.

In case of occurrence of any of the complications named above, it is necessary to contact the Loote Ultrahelikeskus on weekdays from 9.00 am to 5.00 pm by calling our administrator at 521 0046 in advance. During non-working hours, we recommend contacting the emergency clinic of the East Tallinn Central Hospital Women's Clinic or the West Tallinn Central Hospital Women's Clinic.

What happens after medical termination of pregnancy?

Your next period should start 4 to 6 weeks after the termination of the pregnancy, and if this has not happened or if you have other abortion-related complaints (lower abdominal pain, bleeding over 6 weeks, unpleasant smell in the vaginal discharge), it is necessary to attend a repeated visitation to the gynaecologist.

For two weeks after an abortion, it is not recommended to have sex without a condom, use vaginal tampons, go to the bath and sauna, and swim.

When an emotional crisis occurs after an abortion, it is advisable to contact Kristi Kuura a pregnancy crisis counsellor at the Confido Health Center.

In the absence of complaints, it is recommended to come to the post-abortion checkup after the next menstrual period.

How to avoid unwanted pregnancies?

After an abortion, the possibility of getting pregnant is restored immediately, so an effective method of contraception must be started immediately after abortion to prevent a new pregnancy.

Hormonal contraceptives (pills, mini-pills, injectable progestagens) can be started on the same day as the Cytotec tablet, but they are also effective if started within four days of the abortion.

. For the Nuvaring ring and the Evra patch, use should be started no later than the day of Cytotec administration

A gynaecologist can give an intrauterine device or an Nexplanon during a third visit if an ultrasound examination confirms that there is no pregnancy in the uterine cavity.

What are the alternative options for medical abortion?

In addition to terminating a pregnancy with medication, it is also possible to terminate the pregnancy surgically *.

Differences in surgical and medical abortions

Surgical termination of pregnancy	Medical termination of pregnancy
takes place in a day care department in a medical institution. Pregnancy can be terminated at the woman's own request up to 12 weeks of pregnancy (11 weeks and 6 days);	for pregnancies up to 9 weeks (8 weeks and 6 days), the pregnancy can be partially terminated at the patient's home;
necessary surgical enlargement of the cervix and cleaning of the uterine cavity with either a curette or a vacuum nozzle;	does not require surgery;
necessary general anaesthesia;	general anaesthesia is not necessary;
less autonomy and privacy;	patiseint controls your body, more privacy and independence. Abortion occurs as in the case of spontaneous abortion;
rapid, abortion at one moment;	more time-consuming, the abortion lasts longer;
abortion can be assessed immediately;	more visits may be needed to assess the occurrence of an abortion;
If the patient is under general anesthesia during abortion, he may experience lower abdominal pain and vaginal bleeding immediately after abortion. Post-procedure complications such as puncture of the uterus with a curette or vacuum nozzle are rare;	the patient is not under general anesthesia and experiences abdominal pain and vaginal bleeding (rarely nausea, diarrhea, fever, chills) during pregnancy, and may therefore require symptomatic treatment;
post-bleeding is low and short;	post-bleeding occurs for 10-14 days, rarely up to 45 days;
in about 1:50 cases, it is necessary to repeat the surgical abortion due to an incomplete abortion;	approximately 1:20 requires surgical termination of the pregnancy due to prolonged or increased post-bleeding or incomplete termination of the pregnancy;
For whom medical abortion is not suitable. Look above.	Who especially benefit from medical termination of pregnancy. Look above.

* Pregnancy cannot be surgically terminated at the Loote Ultrahelikeskuses.

See the treatment fees

Medical termination of pregnancy

First appointment with a gynecologist

Second gynecologist's appointment

Third gynecologist's appointment

Bleeding

Continuation of pregnancy

Incomplete abortion

Inflammation of the pelvic organs

Differences in surgical and medical abortions