Overview

We understand that making the decision to end a pregnancy due to fetal abnormality, or for medical reasons, can be a very difficult and emotional time for you. 

This information will explain what happens next and advice for the future. You will also be given our booklet called When your baby dies, which has lots of information about what to do after the termination of your pregnancy. It also has details about many charities and support services that you might find useful.

How the procedure is done

The process takes place in two stages. We use tablets to start (induce) a miscarriage. It is recommended by the Royal College of Obstetricians and Gynaecologists for safe termination at this stage of pregnancy. 

We will discuss the procedure with you, and ask you to sign a consent form. 

Alternative procedures

The are no alternative procedures for termination at this stage of pregnancy. 

Stage one of the procedure

We will give you a medicine called mifepristone, which is a tablet that you swallow. 

Mifepristone works by blocking the action of progesterone, which is a hormone needed to maintain a pregnancy. In other words, it switches off the pregnancy hormones.

This tablet will be given to you in the fetal medicine unit at St Thomas’ hospital. You will need to stay in the unit for about 30 minutes after taking the tablet in case you are sick. 

Mifepristone can usually be taken safely but may not be suitable for everyone. We will check your medical history and any other medicines you are taking, to make sure that this treatment is suitable for you.  

Side effects of mifepristone

Mifepristone does not usually cause any side effects but, as with all medicines, these can occur. These can vary from person to person but may include:

• bleeding from your vagina 
• cramps or period-type pain
• feeling sick or being sick
• headaches
• skin rashes

Very occasionally, you may get signs that your miscarriage has started before your next visit to hospital. Contact a member of staff if:

• you have period-type pains, which are worse than usual
• you have increasing bleeding 
• fluid leaks from your vagina 

Additional procedure if 22 weeks’ gestation or later

If you are 22 weeks’ gestation or later, we recommend a procedure called feticide. This is in line with national guidance. It is an injection to stop the baby’s heart so when the baby is delivered they are not alive. We will discuss this with you.

This procedure is done in the fetal medicine unit before we give you the mifepristone tablet. We will give you a local anaesthetic injection in your tummy so that you do not feel any pain. We use ultrasound to guide a needle through your tummy into your womb to carry out the procedure.

There are a few risks from having a feticide which include:

• pain
• infection
• a long or difficult procedure which may mean that you need a break. The procedure would then be repeated later on the same day

Stage two of the procedure

You will be given a date to be admitted to the Butterfly Suite at St Thomas’ hospital, 48 hours after taking mifepristone. You will be in a single room with en-suite bathroom facilities. Your partner, a relative, or a friend will be able to stay with you if you wish. You can eat and drink normally.
 
A tablet called misoprostol will be inserted into your vagina. This medicine causes contractions which helps your body deliver the baby and placenta. You may need up to 5 doses, given every 3 hours. The later doses may be given by mouth but this can make you feel sick or have diarrhoea. 

If you have previously had a caesarean section or major surgery on your womb then we will give you a lower dose. This is to reduce the risk of problems with your scar. 

How long the process takes is different for everyone. You should plan to be in hospital at least 1 night. We can give you pain relief at any stage if you need it. 

If you wish, you can meet with a specialist bereavement nurse who will be able to offer support and advice, and let you know about counselling services.

Side effects of misoprostol

As with all medicines, people can have side effects with misoprostol. These can vary from person to person but may include: 

• tummy (abdominal) pain
• feeling or being sick
• diarrhoea

Please let us know if you have any side effects or if you have any questions or concerns.

Babies born with a heartbeat

If your termination was before 22 weeks you will not have had the feticide procedure to stop the fetal heartbeat. Very occasionally your baby may be born with signs of life. If this happens the baby’s birth and death will need to be registered.

Your midwife will support you at this time and there is more information about this in our booklet called When your baby dies.

Breast milk

We will offer you a tablet called cabergoline which will reduce the chance of you producing breast milk.

What to bring to hospital with you

As you will be in hospital for at least 1 night, we recommend that you bring with you:

• any medicines that you are currently taking
• glasses or contact lenses and cases
• toiletries
• towel
• disposable pants
• sanitary towels
• slippers or flip-flops
• T-shirt or nightdress for the delivery
• light refreshments, such as water and snacks
• phone charger
• books or magazines

Problems or complications

Most people do not have problems when they have a termination of pregnancy, but these can happen.

At the time of the termination these can include:

• The placenta being retained within the womb (uterus) after the baby is delivered. This can happen in 1 in every 20 (5%) procedures. Medicine may help your body to deliver the placenta, but if this is not successful then you will need a short operation. This is done through the vagina. You would have a general anaesthetic, so that you are asleep, for this operation.
• Excessive bleeding. This can happen in 1 in every 1,000 (0.1%) procedures. You may need medicine to stop the bleeding, and sometimes a blood transfusion.
• Damage to the womb, for example a tear (perforation). If you have not had a caesarean section or major surgery on your womb, there is a less than 1 in 1,000 (less than 0.1%) chance of this happening 

After the termination, but may not be evident until days or weeks later, include:

• Infection. This can happen in up to 1 in 10 (10%) cases. You will be treated with antibiotics if you get an infection.
• Incomplete emptying of the womb, such as retained placental or fetal tissue, or blood clots. This can happen in up to 2 in 100 (2%) cases. You may need intravenous antibiotics  (given through a drip) and an operation, to make sure that the uterus is empty, followed by a course of antibiotic tablets. This operation would be under general anaesthetic.

Seeing, holding and spending time with your baby (optional)

After the delivery, your baby will be wrapped in a small blanket. You are welcome to bring your own blanket, or clothes (depending on the stage of pregnancy), if you wish.

Thoughts about seeing or holding your baby are often very mixed. It can be a difficult decision to make and there is always the option to change your mind. If you wish to, you can see, hold and spend as much time as you like with your baby. Some people may wish to see the baby at some point, others may not. We will respect your wishes and support you with either choice.

Mementos

Many of our families have told us how important it is to have keepsakes to show to family, friends and children. We will help you to have or create mementos that feel right for you and can offer you comfort in the future. These can include memory boxes, wristbands and certificates. Where possible, and depending on the gestation of the pregnancy, this may also include photographs, handprints and footprints.

Investigations

Depending on the gestation of your pregnancy, and the reason for the termination, we may offer to carry out a post-mortem examination. This would be to investigate what could have contributed to any issues your baby may have had. Although a post-mortem examination doesn’t always find a definite cause of your baby’s abnormality, it may answer some questions, provide new or extra information or confirm the clinical diagnosis.  

We will discuss this with you while you are in hospital, and explain what a post-mortem involves. It will be your decision and we will not do one without your consent.