[CG] Early medical termination of pregnancy in the home setting

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Evidence from national research and local audit activity has demonstrated that early medical termination at home is a safe procedure which offers additional choice to women requesting termination of pregnancy.

Women meeting the inclusion criteria will be offered the option to attend the hospital for mifepristone administration, return 48 hours later for the administration of misoprostol and be given the opportunity to go home to abort.

Inclusion Criteria

  • Age 16 or above.
  • Gestation at the time of misoprostol < 63 days.
  • Singleton pregnancy.
  • Language – must be fluent in English and be able to read English.
  • Must stay within 30-45 minutes from a GG&C Gynaecology unit.
  • Must have transport available.
  • Must have immediate access to support at home if required.

Clinic Visit

  • Consultation as per normal referral at the clinic visit.
  • Patient will be risk assessed and MUST fit the inclusion criteria.
  • The consent form will be signed and stored in the casenotes.
  • Bloods will be taken for G+S and FBC.
  • Patient will be given the Early Discharge information leaflet (appendix 1).
  • The follow up pregnancy test information (appendix 1) will be given in conjunction with a pregnancy test.
  • If the pregnancy test result shows “risk of termination failure” then the patient should contact Sandyford.

Mifepristone Day

  • Ensure appropriate documentation is available.
  • Check consent form is signed.
  • Ensure intra-uterine pregnancy is confirmed by ultrasound scan.
  • Check paperwork in the ICP.
  • Check the patient is sure of their decision.
  • Mifepristone 200mg PO will be administered in the gynaecology day ward (except when the patient has been given this at the clinic).
  • Advise patient to return to the ward if she vomits within 1 hour.
  • Ensure advice is given to the patient regarding pain and/or bleeding they may experience over the following 24-48 hours.
  • Ensure the patient has the ward telephone number.
  • Relevant information should be documented in the ICP.

Misoprostol Day

48 hours following mifepristone.

  • Arrive patient under ward attenders on Trakcare.
  • Nurse enquires about pain/bleeding/passage of products of conception.
  • Check BP, pulse and temperature.
  • Explain the procedure to the patient including information about expected PV bleeding/ abdominal pain/ passage of tissue.
  • Patient is NOT routinely required to fast.
  • Misoprostol 800mcg is administered PV (this may be self administered.)
  • Metronidazole 1g is administered PR (this may be self administered.)
  • Diclofenac 100mg is administered PR as prophylactic analgesia unless contraindicated (this may be self administered.)
  • Anti-D prophylaxis MUST be given to ALL rhesus negative women.
  • Give prescribed contraception – COCP, POP, implant or Depo-provera prior to discharge. If the patient requires an IUCD or IUS they should attend Sandyford or their GP after their pregnancy test has established they are not pregnant.
  • Azithromycin 1g PO.
  • Discharge analgesia should be offered.
  • Ensure the patient has a pregnancy test to do in 2 weeks time.
  • Relevant information should be documented in the ICP.
  • Outcome patient under ward attenders on Trakcare.
  • Ensure the patient has contact phone numbers and advise them that they may telephone the ward today and then Sandyford with any queries/problems.

Follow Up Pregnancy Test at 2 Weeks Post Procedure

The patient will have been advised to do a pregnancy test 2 weeks after being administered misoprostol. They will be informed to contact Sandyford if the result states “there is a risk of termination failure” or if they have any concerns.

Appendix 1: patient information

Next review: 30 September 2022

Author(s): Elena Young

Approved By: Dr R.Jamieson, Clinical Director