Aftercare Instructions for Medical Abortion

Medical Abortion Aftercare
Knoxville Center for Reproductive Health

1547 W. Clinch Ave, Knoxville, TN 37916 (865) 637-3861

Medical Abortion After Care Instructions

You have chosen a medical abortion for your termination.  Remember, this is a two-step process; both medicines must be taken to complete your abortion. Today in the clinic our physician has given you the first medication, Mifeprex, and an antibiotic taken orally. This medicine rarely causes symptoms, but may cause nausea, spotting, cramping or bleeding in some women. You also have received packets of Misoprostol, Phenergan and prescriptions for pain medication.

24-48 hours after leaving the clinic you will insert the 2nd medication, Misoprostol tablets, buccally (between the cheek and gum in your mouth) to dissolve.  This medicine will cause the major cramping and bleeding that may start within a few hours of insertion. Plan to stay home and rest for the following 2 days.  *Remember, if you have taken Mifeprex you must take the Misoprostol tablets to complete the abortion and avoid any possible birth defects or complications.

A follow up exam is necessary in 2 weeks after treatment. Return to the clinic on _________________________ at __________ for a free follow-up exam to ensure that the abortion is complete.  At this time you can discuss and obtain continuing birth control.  If you are 21 years of age or older, you can also get a pap smear for $30 (or covered by insurance; bring your insurance card).

Each visit is extremely important. If you fail to return for your follow up, we will contact you by phone or mail. We may leave a message that “K.C. called.” Please call us back immediately to discuss your treatment.

If you have an EMERGENCY, call us at (865) 637-3861, 24 hours a day. After hours, the answering service will take your name and number. A staff member will call you back as soon as possible.  Please do not call the toll-free number, as it will not be answered after hours. Should you have an emergency, please call us before seeking medical care elsewhere. We are committed to meeting your needs at our facility if possible, at no additional charge.

Getting Prepared:

After leaving the clinic, take your prescriptions to the pharmacy and have them filled.  (Kentucky residents must fill your hydrocodone prescription in Tennessee). You may fill your prescription for Ibuprofen OR purchase over-the-counter Ibuprofen (Advil or Motrin). Also, purchase a box of large overnight-sized maxipads.

We have provided you with an easy-to-follow checklist to walk you step-by-step through the process from the time you leave the clinic until after inserting the Misoprostol tablets in your cheeks.

To minimize nausea, vomiting, or diarrhea, eat lightly for the next 2-3 days. Avoid greasy or spicy foods. Drink plenty of fluids throughout the abortion process.

What to Expect:

 Bleeding: Bleeding can vary greatly from person to person. Some women have very light bleeding that lasts a short period of time.  Other women experience very heavy bleeding that exceeds a normal period. You will probably start bleeding within a few hours after the Misoprostol is dissolved. You may pass blood clots that range in size from very small to quite large (the size of golf balls or lemons). The heaviest bleeding usually begins as the pregnancy is moving out of the body, and lasts about 2-3 hours. Once the pregnancy has passed, bleeding often will begin to subside to a flow similar to a normal menstrual period. You may have light to moderate bleeding or spotting off and on for several days. The average duration of bleeding is 9-16 days, though you may experience some bleeding for 4-5 weeks.

Most women will pass the pregnancy within 24 hours after the Misoprostol. Many expel it within 2-4 hours. While the pregnancy is very small at this stage, you may see tissue, including the pregnancy and lining from the uterus, passing from your vagina.  In a small number of cases, it can take days or weeks for the pregnancy to be expelled. Heavy bleeding and the passage of clots may be experienced weeks after the treatment, possibly after your follow-up exam. Rarely, additional medical treatment may be required after your follow-up exam.  Your next menstrual period may be heavier than normal, and include passing more blood clots.  Remember, if you have no bleeding 48 hours after inserting the Misoprostol, call us.

Cramping: Cramping can also vary greatly from person to person. For many women, the cramping can be quite painful and intense at times, though it tends to subside to mild cramps after passing the pregnancy. Some women experience only minimal discomfort.  Cramping may last off and on for a few weeks. Take Ibuprofen as directed for pain alternating with the prescription pain medication, if needed. A heating pad and rest will also help.

Nausea, Vomiting or Diarrhea: These symptoms can occur as a result of pregnancy, or as side effects of Mifeprex and Misoprostol. You will be given Phenergan tablets to treat these symptoms if needed. Also, eat a bland diet and drink plenty of fluids.

Fever:  Fever may occur as a side effect of Mifeprex and Misoprostol. You may also experience chills and hot flashes. Please call us if you have a fever (over 100.4 F) that persists for more than 24 hours, as ongoing fever could indicate an infection.

Effectiveness:

The combination of 200mg of oral Mifeprex followed in 24-48 hours by 800mcg of Misoprostol buccally (inserted between your cheek and gum) is highly effective.  Studies show this regimen to be approximately 98% effective up to the 49th day (7 weeks), 95% effective up to the 63rd day (9 weeks), and 92% effective up to the 70th day (10 weeks) of a pregnancy. Pregnancies beyond 49 days (7 weeks) gestation may be associated with a slightly higher rate of complications such as excessive bleeding, incomplete abortions, and ongoing pregnancy.

 Possible Complications and Risks:

 Medical (Mifeprex and Misoprostol) abortions are very safe and effective. Studies show that 92-98% of pregnancies are successfully terminated by these medications, without further medical intervention. However, as with any medical treatment, some risks are involved, including the following:

Incomplete Abortion: Some tissue may remain in the uterus.  If this occurs, the provider will discuss your treatment options which may include waiting one or more weeks or having an aspiration curettage (a surgical abortion) at our clinic at no additional cost. The risk of an incomplete abortion requiring an aspiration curettage is less than 8 in 100 (<8%).

Vaginal Bleeding: Approximately 1 out of 100 (1%) women experience heavy bleeding that requires an aspiration curettage to treat. If it is not an emergency, the aspiration can be performed through this clinic at no additional cost.

In rare situations, hemorrhage (very excessive bleeding) can occur and may require emergency treatment at your local hospital.  Hemorrhage can occur several days or even weeks after treatment.  Hemorrhaging may develop after your final follow up exam, and can be associated with your next menstrual period. Please call us if you experience excessive vaginal bleeding within 6-8 weeks after your medical abortion. While rare, approximately 1 out of every 1000 women will need a blood transfusion as a result of hemorrhage after using Mifeprex and Misoprostol.

Continued Pregnancy and Birth Defects: Your pregnancy may not be terminated by these medications. Severe birth defects are very likely if the pregnancy continues. Surgical abortion is strongly recommended to end the pregnancy.

Ectopic/Tubal Pregnancy: A pregnancy not located in the uterus is called an ectopic or tubal pregnancy.  Mifeprex/Misoprostol will not end an ectopic pregnancy, which is a medical emergency requiring immediate medical attention. The Knoxville Center for Reproductive Health does not treat ectopic pregnancies. Symptoms include:  one-sided abdominal pain, nausea, chills and fever, and/or shock (fainting, weakness or cold sweat).

The chance of developing a complication is small.  Try not to worry in advance, but do make a plan of whom you will call and where you will go in the event of an emergency.  Please call us—and follow our instructions—if you have problems.

Surgical abortion (or aspiration curettage): Approximately

2-8% of women using Mifeprex will require an aspiration curettage.  This procedure lasts 5-7 minutes and involves slightly opening the cervix, inserting a small tube into uterus, and then emptying the uterus by suction.  Rare complications include excessive bleeding, failure to remove all of the tissue from the uterus, infection, tearing of the cervix, and making a hole in the uterus.

Birth Control:  The Knoxville Center for Reproductive Health offers a variety of birth control options. You may have received a sample or prescription for birth control to begin the first week after your abortion. Other options can be discussed and prescribed at your follow-up exam.

Remember We Are Here to Help!

The Knoxville Center for Reproductive Health hopes to provide services that meet your individual needs, both emotional and physical. You will respond to your abortion in your own unique way. Many women feel relieved that they are no longer pregnant, and resume their normal activities very soon. Some women may experience mixed feelings of gladness and sadness. Most women do not have any long lasting emotional or physical problems after an abortion. If you do need someone to talk to after your abortion, we have caring, supportive staff who are specially trained to help you.  If we can assist you further with your healing, please do not hesitate to call us. If you are pleased with our services, or have any suggestions that would be helpful for other women in need of our services, please let us know.

For your health, safety, and comfort:

*It is recommended to avoid strenuous exercise for7 days.

*Have nothing in your vagina (no sex, tampons, sex toys, or douching) for 7 days.

*Do not do a home pregnancy test; it may stay positive for 3-6 weeks even though the pregnancy is terminated.

Please call us if:

*If you soak through more than 2 thick overnight-sized maxipads within an hour, for more than 2 hours in a row or passing clots larger than lemons.

*You have no bleeding or spotting within 48 hours of using the Misoprostol tablets.

*You have an onset of fever (100.4 or higher) that develops and persists for 24 hours or more.

*You have ongoing, severe cramping not relieved by Ibuprofen and the prescription pain medication.

Medications:

For Cramping/Pain: Ibuprofen (Advil or Motrin).  You have been given a prescription for Ibuprofen 800mg.  Take one (1) tablet up to three (3) times a day.  This is the same as taking four (4) 200mg over-the-counter Ibuprofen tablets.  Do not take aspirin as it may promote more bleeding. You will also be given a prescription for pain medication, usually a combination of hydrocodone and acetaminophen. You may take one (1) tablet every 6 hours as needed. It may make you drowsy. Take this medication between your doses of Ibuprofen.

For Nausea and Vomiting:  You will be given a packet of Phenergan. You may take one (1) tablet every 4-6 hours if needed.  It may cause extreme drowsiness and impair judgment. You have agreed not to drive or operate machinery for 12 hours following use of this medication.

Do not take any medication or herbal supplement that you have not previously discussed with our staff.  Some medications and herbs will inhibit Mifeprex and Misoprostol from working effectively.

We hope we have been able to provide you with services that met your individual needs. If you were pleased with our services or have suggestions that would be helpful to other women who might need our services, please feel free to let us know or complete our Patient Evaluation Survey.

Last updated:  4/16