You have an unwanted pregnancy at a gestational age where we cannot see the pregnancy on ultrasound.

What is medical ToP?

We will give you all the medication needed. You will be given medicine to start the termination process, painkillers and an antiemetic drug.

It is very important that you have a responsible adult at home with you, in case you need help.

You will be instructed to take the medication be taken in this order:

1. Mifepriston/Mifegyne®: This pill is swallowed. It is given to you in the hospital. The pill can cause small amounts of bleeding and period-like pain.
2. Misoprostol/Cytotec®: 24 to 48 hours after you have taken Mifegyne, four tablets of Cytotec are inserted deeply in the vagina. You need to lie down for one hour after inserting the tablets. Cytotec will cause contractions in the uterus and the pregnancy will be expelled. We recommend taking the Cytotec in the morning, and we expect the termination to start after 3 to 4 hours. A responsible adult must be with you during the first 24 hours after taking Cytotec.
3. Paracetamol and ibuprofen: We recommend that you take two 500 mg tablets of paracetamol and one 400 mg tablet of ibuprofen orally around the same time as inserting the Cytotec.
4. Morphine: In case paracetamol and ibuprofen is not enough to control the pain, we will give you two 10 mg tablets of morphine. You can take one 10 mg tablet every 8 hours. The tablet can be split into 5 mg halves, which then can be taken every 4 hours.
5. Metoclopramid: Morphine can cause nausea, and we will give you 1 tablet of 10 mg metoclopramid to take if you experience nausea during the process.

You can expect heavier vaginal bleeding than your period. You can also expect some pain. The pain usually stops later in the day, but the bleeding can continue for a few weeks. If you are feeling very unwell or nervous, you can contact our department. If you do not experience bleeding 48 hours after inserting Cytotec, you should contact us.

You need to have a blood sample (hCG level measurement) taken one week after you use Cytotec, meaning _____day, _____________ (date)

If the level of hCG has decreased sufficiently there is no need for further evaluations.

Can I expect complications?

The majority of ToPs have no complications. A rare complication is infection of the uterus, which is treated with antibiotics.

To reduce the risk of infection during the period of bleeding, we recommend:

1. Avoiding bathtubs, swimming pools and swimming in the sea
2. Avoiding having sexual intercourse without using a condom
3. Using a menstrual pad instead of a tampon or menstrual cup

When the ToP takes place before the pregnancy can be visualized on ultrasound, there is a small risk of an ectopic pregnancy (<2%). If this is the case, the treatment does not work and there is a risk of rupture of the pregnancy. This causes bleeding in the abdomen and severe pain. Should this happen, you must contact us immediately. See contact information below.

If your bloodtype is rhesus negative

When you have a ToP this early, there is no need for rhesus prophylaxis.

When can I conceive again?

Before your first menstrual period after you ToP, you will ovulate and can thus become pregnant again. It is therefore important that you have a plan for future contraception. Combined oral contraceptives (“The pill”) or progestin-only oral contraceptives should be started on the day where you insert Cytotec. An IUD or implant can be inserted by your general practitioner as soon as the ToP is over. We can prescribe all types of contraception in the outpatient clinic.

Contact us within the first 72 hours if you experience:

• Heavy bleeding (more than 2-3 filled menstrual pads every hour)
• Fever (temperature above 38⁰C / 100,4 ⁰F)
• Foul-smelling discharge
• Severe pain
• If you are feeling very unwell

Weekdays 8:00 to 15:00: Call Gynækologisk Ambulatorium 537 at telephone 38 62 21 42.

Weekdays 15:00 to 8:00, weekends and holidays: Gynækologisk Akutklinik 414 at telephone 38 62 31 91.

If you develop the above stated symptoms after 72 hours you must call your general practitioner or 1813.