Late medical termination of pregnancy (10+1 to 17+6 weeks pregnant)
Date issued: May 2026
Review date: March 2028
Leaflet section: SHiP
PDF: Late medical termination of pregnancy.pdf [pdf] 166KB
Pregnancy Advice Service (PAS): 01752 431129
Ocean Suite: Orange Zone D, Level 6, 24 hrs, 01752 432624
Counsellor: 01752 431129
Step 1:
PAS Clinic Oral tablet (mifepristone) administered at the PAS clinic
Step 2:
Admission to hospital
Approximately 36-48 hours following Step 1 you will be admitted to the hospital for repeated doses of medication (misoprostol) to complete the abortion process.
An overnight stay is sometimes required so please bring everything you might need including all your regular medications.
Step 1
You will attend the clinic for assessment and preparation for your admission which will include an ultrasound scan to confirm how many weeks pregnant you are. This may need to be done even if you have already had an ultrasound scan elsewhere. We will only repeat the ultrasound scan if necessary and the reason for this should be explained to you.
A blood test will need to be taken to check for anemia and to check your Rhesus status. If you are Rhesus negative, you will be given an anti-D injection while admitted.
We aim to offer women the first dose of medication at their clinic assessment appointment, but this is not always possible, as it is dependent on a bed being available in the hospital.
The first medication is called MIFEPRISTONE, which is taken by mouth, with water. This tablet works by blocking the effects of one of the main pregnancy hormones. Once you have taken this tablet the termination process has started, and it is not possible to reverse it, which is why you must be sure this is the right choice for you before you take it. The medication may affect an ongoing pregnancy and cause abnormalities during the development of the baby.
Some important points for after taking mifepristone:
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Mifepristone can make you feel sick and there may be vomiting or diarrhea,
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headache, dizziness
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rarely a skin rash.
If you vomit within 2 hours of taking the tablet, contact us immediately on 01752 431129. We will arrange for you to return for a further dose.
You may experience some spotting or light vaginal bleeding before the next step. This is normal.
You can eat and drink as normal and carry on with your usual activities. Please avoid alcohol.
A very small percentage of women can start to miscarry after taking only the Mifepristone. If you think this is happening, please contact Ocean Suite for advice 01752 432624.
Step 2: approximately 36 to 48 hours after step 1
The second part of the process involves inserting 4 tablets of MISOPROSTOL into the top of your vagina. They need to be pushed into the vagina as far as possible and the nurse can do this for you or you can do it. They are given into the vagina to give you the highest possible chance of successfully ending the pregnancy. Misoprostol is not currently licensed for use in abortion but has been shown to be safe and effective and is widely used in the UK. Misoprostol, in combination with the first tablet, causes uterine contractions so the pregnancy is passed with cramping and heavy bleeding.
The amount of pain and bleeding is variable, depending partly on how many weeks pregnant you are and whether tissue passes easily. Pain relief medication will be prescribed for you during your admission and at home afterwards you can use simple pain relief like paracetamol and ibuprofen.
Three hours after the vaginal misoprostol, a further dose of 2 misoprostol tablets is given, usually under the top lip. We recommend holding the tablets in your gums for 30 minutes and then swallowing with a glass of water. This dose is repeated every 3 hours until the pregnancy is passed. The healthcare professional looking after you will try to make the process as comfortable as possible and anti-sickness medication will be available.
On average it takes 6-8 hours to pass the pregnancy. In some cases, it will be a quick process but in other cases it may take longer, even over 24 hours in which case you will need to stay overnight in hospital.
You may see large blood clots or the fetus at the time of the abortion. The doctor will discuss with you in clinic your options for disposal of the pregnancy and whether you wish to see it or not. The nurse(s) can support you to try to ensure that you see very little, but sometimes this is not possible as events can be rapid.
In a small number of cases (up to 13 in 100 people- depending on how many weeks pregnant you are) the placenta or afterbirth does not pass. In this case, you may need to have an additional procedure (operation) under a general anesthetic to remove the placenta.
It is normal to have bleeding and cramping but you might also experience the following:
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feeling dizzy
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feeling nauseous (sick) or vomit
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have a headache
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have diarrhoea
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have temporary flushes or sweats
It’s normal to have period like bleeding or spotting for up to 4 weeks after the abortion. It should gradually settle over this time. You should use sanitary pads as it makes it easier to keep track of your bleeding and may help reduce the risk of getting an infection after the procedure.
Risks and complications:
The process is slightly unpredictable in terms of time to complete the procedure. This means some women may need an overnight admission. This is often due to the process not progressing as we hoped and further medication will be prescribed.
Side effects of medications used as listed above.
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Heavy bleeding (haemorrhage) is a risk and may require a blood transfusion (1-10/100). This can be due to retained pregnancy tissue and require an operation to remove it. This is more common the further on the pregnancy is (up to 13/100).
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Infection in the first 3 - 4 weeks (numbers not known) Use sanitary pads not tampons for all the bleeding after the procedure, avoid sexual intercourse until the bleeding has stopped and seek help if you develop a fever, flu-like illness symptoms, abnormal vaginal discharge, pelvic/ abdominal pain, fluctuating vaginal bleeding- alternating heavy/ light vaginal bleeding
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Unpredictable bleeding after the procedure - seek help if the bleeding is not settling over 3-4 weeks, it should get less and less
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Pain during the procedure but pain relief will be provided during your admission.
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Rupture of uterus - a rare complication which is more common the later you are in pregnancy and is increased for those who have had one or more caesarean sections. This can result in the need for extra procedures such as laparoscopy/ laparotomy or hysterectomy (removal of the womb) 2/100 000
After the procedure
If you experience any of the following after you are discharged home, please contact your Ocean Suite Derriford on 01752 432624 or GP/NHS Advice Service 111. You will be given open access to the ward for 1 week after your discharge so you can contact them if there are problems. Call an ambulance (999) if you are very concerned about the amount of bleeding
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you have excessive abdominal pain
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you develop a smelly vaginal discharge
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you have a temperature and feel unwell
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feeling sick, diarrhoea, vomiting or weakness more than 24 hours after taking Misoprostol (vaginal tablets) could be a sign of a serious infection - seek help immediately
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there is heavy vaginal bleeding (using more than 2 pads an hour for 2 hours)
Breast tenderness, fullness and milk production can occur after the procedure. Wear supportive underwear and take pain relief if needed. This does not usually require medication to suppress milk production but please seek help from your GP if any area of your breast becomes red/ hot/ severely tender as infection can occur in a small number of women.
Sensitive disposal of fetal remains
At the time of your clinic appointment the doctor will discuss with you how you wish the pregnancy remains to be disposed of. The options are; burial, incineration or making your own arrangements.
Some women will feel unable to discuss this as they find it too upsetting. If this is the case, please let us know and we will continue with the standard procedure which is shared burial.
You will have a 4-week period of time to change your mind about this option. If you change your mind you need to contact us on the following email:
plh-tr.pregnancylossarrangements@nhs.net and we will call you back to discuss your options. Please note this email is only monitored between Monday and Friday 9am till 4:30pm.
Follow-up
No follow up is needed unless you are concerned that bleeding is not settling and that tissue may be left behind. If you have any concerns please call us on 01752 431129 and we can arrange further follow up.
Contraception
You will have had the opportunity to discuss contraception at your clinic appointment.
If you decide to take the oral contraceptive pill or the patch you will need to start on the day following your operation, but please remember if you suffer from sickness and diarrhoea this will affect the way the pill works. You must follow the instructions for your particular pill if you suffer from vomiting and/or diarrhoea and use extra protection (condoms) during this time.
If you request the injection, called Depo Provera, this will be given to you on in the recovery ward after your operation and must be repeated at 12-13 weekly intervals.
If you have had an IUS/IUD or implant fitted during the procedure, then this is effective immediately.
If you have chosen an implant this is usually fit on the same day as your operation but occasionally booked for a few days afterwards due to staffing pressures. It is important to not have any sex until it is fitted, and you are advised it is effective if there has been a delay.
We can provide free condoms from SHiP at your initial appointment
If you or your partner is considering sterilisation, you need to make an appointment with your GP who will arrange a referral to discuss this further.
EMERGENCY CONTRACEPTION can be obtained from many local pharmacies, the SHiP or your GP. If taken correctly it can be effective at preventing pregnancy, but we would recommend alternative methods for the long term. We can support you finding something appropriate for your circumstances.
Confidential counselling service
This service is provided for Pregnancy Advice Service (PAS) by a professional counsellor. Counselling may be helpful to address the emotions and thoughts that can arise prior to a termination. The counsellor can also talk with you about the emotional processes that might follow the termination and what signs to watch out for indicating that further counselling may be of benefit to you. Some women may wish for a further opportunity to speak to the counsellor after their clinic visit and before their procedure. This can be arranged and will take place at the clinic premises or over the telephone.
The Pregnancy Advice Service (PAS) also offers a post termination counselling session for up to a year after your procedure; you may arrange this by telephoning the Pregnancy Advice Service (PAS) on the telephone number on the front of this booklet.
You could also ask your GP if confidential counselling is available through the surgery.
GP letter:
You will have been asked when you make your appointment whether a letter outlining the details of your treatment can be sent to your GP. If you agree to this, a letter will be sent after your clinic appointment. Please retain this leaflet in the event you have any problems, you can show your GP so they are aware of the medications that have been administered. If your GP has signed up to GP Connect they will have the ability to view your full medical records if appropriate, we cannot remove this care from your medical records.
Other formats
If you need this leaflet in another format such as Braille, large print, high contrast, British Sign Language or translated into another language, contact the Patient Advice and Liaison Service (PALS):
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01752 439694
