How to insert the tablet into the vagina, Before you insert the Misoprostol into the vagina, go to the toilet and empty your bowel and bladder. Open the tablets from the packet and have them ready in one hand. lie down on the bed and insert each tablet separately in the vagina as far as your finger can go and repeat with all tablets. Lie down for 15 minutes and then you can move about as usual.

The medications

Medications can be received by royal mail or by courier at no additional charge to reach you the same day.

You are also given the option to collect the medication yourself any time or to arrange for someone else to collect them on your behalf.

The following will be enclosed in the packet:

1. Abortion Pills:
   Step 1: Misoprostol, one tablet to be taken by mouth as soon as possible.
   Step 2: 36-48 hours later, 4 Misoprostol tablets to be taken orally (inserted between the cheeks and gums) for 30 minutes and then swallowed with some water. OR inserted in the vagina as explained below.
   Step 3: If you have no pain or bleeding within 3 hours take 2 Misoprostol orally or vaginally.
2. Painkillers: Diclofenac 50mg & Co-codamol 30/500mg.
3. Low sensitivity pregnancy test.
4. Contraceptive pills. Prescription provided if requested.

How to take the painkillers

Diclofenac 50 mg: Take 2 tablets as soon as cramps start which may be repeated 8 hourly if required. Follow the instructions on the packet.

Co-codamol 30/500mg: Take 1-2 tablets. This can be repeated a maximum of every 6 hours.

Warning: Do not drive or operate machinery when you take Codeine.

Please note that hot water bottles may help to ease the pain.

What to expect after inserting the tablets

It is unusual for any pain or bleeding to happen after taking the first tablet but this can occur occasionally, so we advise wearing a sanitary towel just in case.

Once you've taken or inserted the Misoprostol tablets, in most cases you will experience cramps and period-like pain which can be severe (very rarely this can be like labour pain). The process may take 6-8 hours, during which time you will have bleeding with clots and sometimes you may see a small foetus depending on the stage of the pregnancy.

The cramps and bleeding may continue for a period for 1-2 weeks depending on the duration of pregnancy.

Success and failure of medical abortion

The failure rate of medical abortion is less than 1:100 but it's still very important to check that you are not pregnant after the miscarriage.

How to check that I am no longer pregnant

1. Use the pregnancy test provided. This contains 2 windows: The top window where it is indicated by number 5 (the level of the hormone) is a very sensitive test and is expected to be positive i.e. showing 2 lines ( I I ) even if the treatment is successful. The lower window, indicated by 1000 (the hormone level), should always be negative showing only one line ( I ) if the treatment is successful. If you are in doubt, please phone a nurse at +27638309459
2. We can arrange an ultrasound scan which can be for 2 weeks later at additional cost.

Contact the clinic if...

1. You had no or only minimal bleeding after the second tablet.
2. If the pregnancy test is faint or strong positive after 2 weeks.
3. If you've had no period after 4 weeks.
4. If you continue to have bleeding after 4 weeks.
5. If you still feel pregnant after 1-2 weeks.

Common side effects to the tablets

Nausea, vomiting, diarrhoea, fever, and chills are common side effects. If these happen, just observe, as they usually improve after 24 hours.

Uncommon side effects

In 7% of women placental tissue may remain within the uterus, leading to continuous and sometimes heavy bleeding. This may require surgical evacuation, which may be done at additional cost.

Infection is every rare but do contact the clinic if you have fever for more than 38 hours or if it develops 2-3 days after the miscarriage.

Serious complications

Ectopic pregnancy: Like all pregnancies, you should be aware of the risk of ectopic pregnancy (about 1%) unless you have had an ultrasound to confirm that the pregnancy was inside the uterus. Ectopic pregnancy may lead to bleeding inside the abdomen which can be serious and sometimes fatal unless treated promptly. Ruptured ectopic pregnancy may be manifested by stabbing pain in the lower abdomen associated with bloating, discomfort in the upper abdomen, shoulder pain, dizziness and fainting episodes. If this occurs you should contact 999 or go to hospital directly if your condition permits.

Heavy bleeding: Especially if pregnancy is over 6 weeks, if you soak 9 sanitary pads in < 6 hours, (1.5 litres) you should consider calling an ambulance especially if you are feeling dizzy or if you faint.

Termination of pregnancy has not been found to affect future fertility but has been found to be associated with increased risk of premature deliveries, more so with increased number of terminations.

Contraception

Contraceptive pills can be started immediately after the miscarriage, and we will be happy to provide you with prescriptions for up to one year at no additional charge.

If you desire a contraceptive device, this can be fitted at our clinic during your first period (see our fees on the website) or alternatively, you can visit your GP.

Travel after medical abortion

The process of miscarriage is variable from one individual to another. We advise that you do not travel for 2 weeks after medical abortion. If you do have to travel we suggest that you attend the clinic for an ultrasound scan to be certain that there is no retained placental tissue which might initiate an episode of heavy bleeding during your travel. If you know you need to travel it would be safer for you to have manual evacuation, after which you can travel 24 hours later.