Methods of Abortion by Gestational Age

Download Methods of Abortion Information Leaflet

Although you will have had a positive pregnancy test, your pregnancy may be so early that we cannot see it on the ultrasound scan. This is most common when the pregnancy is less than 5 weeks. If we cannot see the pregnancy on ultrasound, it means that we cannot be sure the pregnancy is developing inside the uterus. Rarely this may indicate an ectopic pregnancy (where the pregnancy grows outside of the womb). Read our client leaflet on ectopic pregnancy.  To treat you we need to be able to see the pregnancy on the ultrasound scan and make sure it is growing in the uterus. We may need to ask you to return for a repeat scan in a week when the pregnancy should be visible on the ultra sound scan or refer you for evaluation in the NHS.

The types of abortion procedures you may have depends on how many weeks pregnant you are and if you would like to be awake or asleep. If you have any medical conditions, this may also affect which types of treatment we can offer you.

 Medical Abortion 

Up to 9 weeks
■ Two medicines are given, either 6-8 hours apart or 1-3 days apart. An overnight stay is not required.
■ At the first visit, the client swallows one tablet of a medicine called mifepristone. Mifepristone blocks the
action of the hormone progesterone on the uterus. This stops the growth of the pregnancy and causes the
lining of the uterus to shed. Some side effects such as light bleeding, nausea, or vomiting may be experienced
before the next appointment.
■ At the second visit, 4 tablets of misoprostol, a prostaglandin, are placed in the vagina near the cervix.
This medicine causes the uterus to contract and also causes bleeding and cramping.
■ Most women go home straight away with advice on what to do after the misoprostol is placed in the
vagina. Most abortions will happen within 4-6 hours.
■ Vaginal bleeding alone does not necessarily mean the abortion is complete and follow-up either with a visit
or by phone is important to confirm that the medicines have been effective.

9 weeks 1 day -23 weeks 5 days
■ Two medicines are given 24-48 hours apart. An overnight stay may be required.
■ At the first visit, the client swallows one tablet of mifepristone.
■ Women who have a pregnancy of 22 weeks or more may have an additional procedure at this
visit. The doctor will put a needle into the uterus and inject medicine to stop the fetal heart. This
may be carried out under local anaesthetic or a light general anaesthetic.
■ At the second visit, the client is admitted to the treatment unit. Four tablets of misoprostol are placed
in the vagina near the cervix. Misoprostol causes the uterus to contract and also causes bleeding and
cramping. The client may also experience nausea, vomiting or diarrhoea. She will be given medication
for pain and other symptoms as needed to keep her comfortable throughout the abortion.
■ Repeated doses of 2 tablets of misoprostol will be given by vagina or by mouth every 3 hours until
abortion occurs. Most women will have the abortion within 6-8 hours of using the misoprostol but for some
women a stay of at least one night will be required.

Vacuum Aspiration 4-12 weeks (Local Anaesthetic)
■ This procedure may be carried out in an operating theatre or a procedure room.
■ An oral analgesic (typically ibuprofen) is given and local anaesthetic is injected into the cervix before the
procedure begins. The client will also have Entonox (“gas and air”) available to use if needed.
■ The cervix is then gently stretched open using thin metal rods called dilators and the uterus is emptied
using a gentle manual or electric vacuum.
■ The procedure typically takes 10-15 minutes and recovery time is 30-45 minutes.
■ An overnight stay is not required.

Vacuum Aspiration 4-15 weeks (General Anaesthetic)
■ This procedure is carried out in an operating theatre.
■ A short-acting general anaesthetic is injected into a vein in the hand or arm.
■ The cervix is then gently stretched open using thin metal rods called dilators and the evacuation is carried
out with either a gentle manual or electric vacuum.
■ The procedure typically takes about 10-15 minutes and recovery time is 1-2 hours.
■ Clients do not need to stay overnight.

Dilatation & Evacuation (D&E) 15-23 weeks 5 days
■ Prior to a D&E, the cervix is prepared. Misoprostol softens the cervix and dilators are placed inside the
cervix to slowly stretch the cervix open. Misoprostol is used 2-4 hours before the D&E whereas dilators are
placed 4-24 hours prior to the D&E. Sometimes dilators and misoprostol are used together.
■ Clients who have a pregnancy of 22 weeks or more will have an additional procedure carried out the day before
the surgery. The doctor will put a needle into the uterus and inject medicine to stop the fetal heart. This may be
carried out under local anaesthetic or a light general anaesthetic. The client may then be able to go home
and return to the clinic the following day for removal of the pregnancy.
■ The D&E is performed in an operating theatre under a light general anaesthetic.
■ Forceps are used to remove the pregnancy and any remaining tissue is removed using vacuum aspiration.
■ An overnight stay is not required. Most women leave the clinic within six hours of arriving.