If any of these side effects make you very uncomfortable, you may treat your symptoms with over-the-counter medicines. Call if over-the-counter medicines do not relieve your symptoms. Most women have bleeding and painful cramping. As you pass the pregnancy, the bleeding is usually heavy and the cramping very strong. This usually lasts one to four hours. Most women pass some blood clots in the toilet and the pregnancy is often one of those clots.
After the pregnancy passes, the cramps decrease and the bleeding slows down significantly. Within a few hours after passing the pregnancy, cramps and bleeding should be much improved.
The last part of the medication abortion process is to confirm with an ultrasound that you passed the pregnancy. This is extremely important because the medicines you took can cause birth defects if the pregnancy continues. At this visit, you will be given a birth control method if desired. Happy with your care at the CWHC? Want to leave feedback for improvement? Take our short Patient Satisfaction Snapshot survey to tell us how we did. Take the survey.
Aftercare Instructions: Medication Abortion This information is a summary of the instructions you will be provided following a medication abortion. When to go to the emergency room If you are having a life-threatening emergency, call immediately.
Day One: The Day of Your Appointment at the Clinic What you should have when you leave the clinic 4 misoprostol tablets Possible prescription for pain medication These instructions and a summary of your procedure including medications and blood type Information on birth control methods that you are considering Antibiotics What to expect after you go home After taking Mifeprex mifepristone : Most women do not have side effects from mifepristone, although some women feel nauseated or have vaginal spotting or bleeding.
When to call the clinic If you vomited shortly after you took the Mifeprex pill, call the clinic and talk to one of the doctors. If you start to bleed heavily and you soak more than two maxi-pads in an hour for two hours in a row, please call the clinic or the doctor at any hour of the day or night. This does not mean you will definitely have to come to the hospital. If you have strong cramps and heavy bleeding and think you might have passed the pregnancy, you may call the clinic the next clinic day to discuss with a doctor if you should use the misoprostol pills or come in for a check.
If you are concerned about the amount of bleeding, call at any time. Preparing for your misoprostol insertion Pick a place to insert the pills that is comfortable and private. You should have a phone, a bathroom, and your support person with you for the day. Bleeding usually stops after weeks, but some women spot until their next period. Sometimes you may have a short episode of pain, with a gush of blood or a clot several weeks after the abortion - contact us if this continues.
A few women don't bleed until their next period is due - and that is normal too. Misoprostol the second medication , causes strong cramps which can be very painful, and heavy bleeding, which can start 2 hours after using the tablets. This lasts a few hours, and is most painful when the pregnancy is being expelled. Many women pass the pregnancy between 2 and 4 hours later - timings vary, but it is OK if this happens sooner or later.
You will be given codeine to help you manage the pain, and you can also use pain relief from supermarkets and pharmacies too.
Please refer to the 'Pain control' section on the 'Abortion pill under 10 weeks' page, for information about managing your pain. Once the pregnancy passes, the pain should reduce noticeably. It is likely you will feel cramping on and off for a week or so after - this should be easily managed with ibuprofen or paracetamol.
Most women experience cramping on and off, for about a week after a surgical abortion. You can take ibuprofen and paracetamol if needed. You can buy these over-the-counter pain medicines from a pharmacy, supermarket and other shops without a prescription. There are two strengths of ibuprofen tablets and you should carefully follow the directions that apply for the strength that you take.
Paracetamol and ibuprofen can be used together if the recommended dose of either medicine alone does not control your pain. After an abortion most women feel relieved, but some also feel sad or guilty. Occasionally, although you feel well physically, perhaps it's a bit of a struggle emotionally. Would you like to talk but you're afraid that people are fed up with you…. Not sleeping well This is normal and talking through these feelings with an experienced listener can help.
If you need to talk you can make an appointment for post-abortion counselling. This is a free service for women who have had treatment at BPAS. Symptoms of nausea, vomiting and tiredness usually stop within 3 days of an abortion. Sore breasts may take 7 to 10 days to disappear. Your breasts may feel firm and tender and leak milk after your procedure.
You will feel more comfortable if you wear a supportive bra and apply cold ice packs to your breasts. Take ibuprofen or paracetamol, if necessary for the pain. Your next menstrual period will begin weeks after your treatment. If you have not had a period 4 weeks after your treatment, you should do a pregnancy test. If it is positive, ring the clinic where you were treated to make a follow up appointment. It's important to remember that any bleeding immediately after your treatment is not a period.
Take a bath or shower as normal. Take care if you have a bath in the 24 hours following a general anaesthetic. You will need to make sure someone is around to keep an eye on you, in case you still feel drowsy.
The objective of the current analysis was to describe bleeding patterns, sanitary product use and changes in haemoglobin following vaginal misoprostol for EPF.
We used data from a randomized clinical trial comparing the efficacy of moistened versus dry misoprostol for medical management of EPF. Women diagnosed with EPF were referred from emergency rooms, residents and clinicians from within the participating institutions. A detailed description of the study methods and results is published separately Gilles et al.
Laboratory tests included a baseline and 14 day haemoglobin level. Each woman received a daily diary to record bleeding for 2 weeks. Participants selected the category of bleeding without guidance or definition by study staff. Participants also indicated the number of sanitary pads or tampons used daily. Haemoglobin measurement was repeated at 2 weeks at the local laboratory.
As per the study protocol, the success rate was calculated at 30 days after misoprostol treatment Gilles et al. There was no difference in success rates between participants who received dry versus moistened misoprostol. The bleeding patterns were similar in the dry and moistened misoprostol groups data not shown. Therefore, the groups are combined and results of the bleeding analyses are presented as one cohort.
Eighty women participated in the trial; 39 were randomized to dry misoprostol and 41 were randomized to moistened misoprostol. Baseline characteristics were similar for the two groups. I Table I presents demographic characteristics for both groups combined. The mean gestational age was 7. Clinicians estimated best gestational age using last menstrual period and sonographic findings.
Most participants completed their diaries. However, some diaries were incomplete especially for days at the end of the 2 weeks.
We excluded three women who never returned diaries, leaving 77 participants with diaries for these analyses. The most common pattern was some bleeding or spotting every day for 14 days. The median number of bleeding or spotting days after treatment was Heavy bleeding was much less frequent than light bleeding or spotting. Participants reported a median of 3 days of heavy bleeding 10th percentile 1 day, 90th percentile 9 days.
The pattern of bleeding over time is presented in Figure 1 by the proportion of participants reporting any bleeding or heavy bleeding by study day. In this figure, days with missing diary data are excluded. Since some participants stopped diary entry when bleeding stopped, this may be an overestimate of the true proportion with bleeding.
Almost all participants bled throughout the first week, with a modest decline during the second week. Heavy bleeding usually occurred during the first few days after treatment and declined sharply thereafter. Reported sanitary pad use was highly variable. The median pad use over 2 weeks was Pad use was similar between study sites. Because some diaries were incomplete, these numbers underestimate the total pads used.
Figure 2 presents the median and 10th and 90th percentiles of pad use by study day. Very few participants used tampons during the study. Infrequent use may reflect investigator instructions. Overall, treatment was associated with small and clinically unimportant changes in haemoglobin.
Before treatment the mean haemoglobin was At 2 weeks, mean haemoglobin was No participant required a blood transfusion during the study.
Published reports emphasize success rates of medical management but provide little information about associated side effects including bleeding. Expected bleeding patterns are an important part of patient counselling and may influence acceptability and choice of medical versus surgical management.
Overall, misoprostol treatment was safe. Clinically important changes in haemoglobin were very uncommon. No participant required blood transfusion. This agrees with other reports using misoprostol for EPF Muffley et al. A few women, however, will experience important blood loss which can be obscured in analyses of mean changes.
This study lacked the power to identify risk factors for uncommon but clinically important decreases in haemoglobin. Since these events are rare, even a large study may fail to identify risk factors.
This study provides the most comprehensive analysis of bleeding after medical management of EPF to date. Daily bleeding for at least 2 weeks was the most often reported pattern.
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