Medical abortion (instruction for the patient, duration less than 9 weeks, partial home implementation)

 Pregnancy less than 12 weeks can be terminated with medication. The advantages of a medical abortion are the avoidance of a procedure (scraping) that interferes with the uterus and anesthesia. Disadvantages include somewhat more abundant and prolonged bleeding and pain associated with uterine contractions. Medication discontinuation is successful in approximately 95% of cases. In about 5% of women, pregnancy may continue or be terminated incompletely. In this case, the interruption is completed by scraping.

· If you have a serious underlying disease or are allergic to the medicines you are taking, there may be risks associated with a medical abortion. In this case, suction scraping is recommended as the interruption method.

· Two different medicines are used to terminate the pregnancy, taken every 1 to 3 days. They can cause birth defects, so after taking the medication, the discontinuation should no longer be canceled.

· Medication interruption can be implemented in part at home. In this case, you will receive the first medicine at the gynecology outpatient clinic and the second medicine will be taken with you at home. Make sure you have an adult available when you are at home.

Visit the gynaecology outpatient clinic.

· On your first visit to the gynaecology outpatient clinic, you will receive an oral mifepristone tablet. The drug increases the sensitivity of the uterus to contraction and softens the cervix. In about half of women, bleeding and menstrual lower abdominal pain begins after taking this drug.

· If you are Rh-negative in your blood type, you will receive an anti-D immunoglobulin injection to prevent the possible formation of antibodies during your next pregnancy.

· Mifepristone tablet taken on ______ / ______ at ______

· If you vomit within two hours of taking the tablet, some of the medicine may not be absorbed. At that time, contact the gynecology outpatient clinic immediately, telephone number: ____________________________

Taking medicine at home

· You will take another medicine, four tablets of misoprostol, with you home. Take your abortion pills by 9 a.m. 1-2 days after taking your first medicine. Put four tablets deep in the vagina. However, if you have heavy bleeding, put the tablets under your tongue (2 tablets at a time every 20 minutes). This medicine causes uterine contractions and clotting.

· 4 misoprostol tablets taken on ______ / ______ at ______

· At the same time, take oral paracetamol 500-1000 mg or ibuprofen 400-800 mg or both as preventative analgesia.

· If the bleeding does not start within the next 1-2 days, contact your gynaecology outpatient clinic.

· Side effects of discontinuation medications may include nausea, diarrhoea, dizziness, and headache. The amount of leakage and the intensity of lower abdominal pain can be surprising. If you have symptoms that you do not cope with at home or have questions about treatment, contact your gynaecology outpatient clinic.

· For example, you can use paracetamol 500-1000 mg 1-3 times a day or ibuprofen 400-800 mg 1-3 times a day or both as an additional painkiller. Book your painkiller at home before you stop.

· If you are breastfeeding, you can continue breastfeeding in the normal way despite a miscarriage.

· If necessary, sick leave is prescribed for 1 to 3 days from the date of taking the misoprostol tablets.

Aftercare

· The leak lasts an average of two weeks, but the individual variation is significant. In the first few days, the bleeding is usually more abundant. Subsequent periods may also be more productive than average. Menstruation begins after about 4-7 weeks.

· Taking care of cleanliness prevents inflammation of the uterus. Use sanitary napkins during post-leakage. Avoid bathing, bathing and having sex without a condom during the after flow. Visiting the sauna is not recommended on the busiest days.

· Taking care of contraception is essential. Getting pregnant again is possible before the next period. You can start taking the contraceptive pill, ring, patch or mini-pill on the evening of the day you take the misoprostol tablets or the following day at the latest. The hormone or copper coil can be placed at a family planning clinic or health center when abortion is confirmed or during subsequent periods. The contraceptive capsules can be placed in connection with an interruption or later in outpatient care. A condom is the only contraceptive that protects against sexually transmitted diseases.

· Problems with abortion are usually associated with incomplete uterine emptying. The leak may be prolonged or profuse. The uterus can become inflamed, causing lower abdominal pain, fever, and bad-smelling bleeding. For these reasons, antibiotic treatment or uterine emptying with scraping is sometimes required. If you experience any of the above symptoms, contact your gynaecology outpatient clinic.

· Follow-up is important to ensure a successful abortion. It will be done 2-4 weeks after the interruption, and you can agree on the place where you received the interruption referral. During the follow-up, the level of pregnancy hormone in the blood is determined. In addition, ensuring the start of contraception is provided, and you can also discuss the feelings associated with abortion.

Survival

· Many experience relief when the interruption is over. For some, abortion can be mentally tricky. The more thoroughly the interruption is considered, the smaller the psychological effects. If necessary, you can seek help from your own health center, mental health office, ward or crisis center.