Medical Abortion

Approximately 5% of women will have a failed medical termination and require a curette. Serious complications are rare but any medical or surgical procedure has potential complications.

Excessive Bleeding

Bleeding is expected with medical terminations. It is most likely to occur within four hours of taking the four misoprostol tablets. It may be much heavier than a normal period. We check your haemoglobin and if it is low, monitor your blood loss.. Haemorrhage requiring a blood transfusion can occur with rates of 1 — 2 in 1000. There is a risk of death if severe blood loss is not treated urgently.

Retained Products of Conception

This complication causes very heavy vaginal bleeding with cramping pain. It happens when the pregnancy tissue has not been completely expelled from the uterus (5%). Extra misoprostol can often help the uterus to expel the rest of the tissue. If not a curette may be required to remove the remaining tissue. We will do this at no extra cost.

Continuing Pregnancy

Occasionally the pregnancy may continue and a curette is necessary. This is less common with early pregnancies and the rate is one in a  two hundred. An assessment with an ultrasound is made two weeks after the initial consultation to ensure that a successful abortion has occurred. A curette will be organised if the medication has been successful.

Infection

Pelvic infection after medical abortion is uncommon. The symptoms of infection are abdominal pain, elevated temperature and vaginal discharge with or without bleeding. When properly treated, future fertility is not affected. There is an ongoing debate about the risks with vaginal application of the four misoprostol tablets. In the USA, there have been deaths from septicaemia (toxic shock) associated with vaginal application. There has been one death in Australia. The incidence is quoted as 1:100,000 — very rare. This has also happened with oral application, but it is even less common. It is possible that these deaths were coincidental and not related to the MTOP. There have been no deaths in Europe where millions of women have had MTOPS.

Our Advice

The risk with vaginal application is very low or zero. However, it is better to be on the safe side and use the oral route. But if you are very nauseated or vomiting from the pregnancy, the vaginal route is less likely to increase these symptoms and should be used. Some women get nausea, vomiting and diarrhoea from the misoprostol and this can be exacerbated with the oral route.

Symptoms of septicemia are feeling extremely unwell, and a high temperature over 38 degrees. If you have any concerns, call the clinic or go to hospital.

Ectopic Pregnancy

About 1 in 200 pregnancies grow in the tube and not in the uterus. Medical abortion is not possible with this kind of pregnancy. If you have an ectopic pregnancy you will be admitted to hospital for treatment. Ectopic pregnancies are very serious and may cause death. If we think you are at risk we will give you a special information sheet.

Psychological Effects

Major emotional or psychological problems after an MTOP are uncommon. They are more likely if you have a pre-existing problem or are pushed into a termination against your will. The clinic can arrange a referral to appropriate counsellors if necessary.

Foetal Abnormalities

Birth defects are normally 2 – 3%. The abortion pill is not known to increase the risk of birth defects, but foetal malformations have been reported after first trimester use of misoprostol. Therefore, you have to complete the abortion once the procedure has begun. You cannot change your mind.

Other Complications

Allergic reactions to the mifepristone or misoprostol are very rare.