- Check blood group and administer Anti D if necessary. If considering giving mifepristone in clinic and blood group is not known, defer mifepristone administration until results available.
- Check STI test results if available. If administering mifepristone in clinic, advise patient of follow up arrangements for positive results. Arrange follow up if required with Health Adviser at Highland Sexual Health.
- Check choice of contraception and provide on-going contraception.
- Administer 200mg mifepristone orally. Advise the patient that if vomiting occurs within 2 hours then she should return for mifepristone dose to be repeated (consider if patient requires admission for day case instead of EMAH).
- Dispense take home pack of prophylactic antibiotics in line with local policy. Advise regarding analgesia.
- Dispense take home pack of misoprostol tablets. Traditional administration has been by the vaginal route, but sublingual and buccal routes are as effective and the patient should be advised on how to self administer by the preferred route.
- If vaginal administration is unacceptable to the patient, then the same dose of misoprostol may be administered sublingually or buccally with similar efficacy. Please note that oral administration (swallowing) of misoprostol has lower efficacy and so oral administration should only be used if the pregnancy is less than 7 weeks gestation and if vaginal, sublingual or buccal routes of administration of misoprostol are unacceptable to the patient.
- The patient should be made aware that administration by sublingual or buccal route is associated with a higher likelihood of headache. Misoprostol tablets administered buccally or sublingually may take approximately 20 minutes to dissolve, may not dissolve fully and are associated with an unpleasant taste in the mouth.
7. The patient should be advised of the standard dosing interval between mifepristone and misoprostol is 24 to 48 hours, based upon efficacy.
Misoprostol should thus normally be administered 24 to 48 hours after mifepristone.
- Longer dosing interval (more than 48 to 72 hours): there is evidence that (less than 63 days gestation) the time interval between mifepristone and misoprostol can be prolonged up to 72 hours after mifepristone with similar efficacy, although the likelihood of heavy bleeding by this time is increased.
- Longer dosing intervals (more than 48 to 72 hours) should only be used if the patient is aware of the likelihood of heavy bleeding with treatment this way and the standard (24 to 48 hours) dosing interval is not acceptable to the patient.
8. Provide patient with patient information leaflet with advice on what to expect at home. Remind patient of when to contact the clinic/ward if they have any signs/symptoms related to the procedure not being effective.
9. Ensure the patient has been provided with:
- Complete drug regime
- Emergency contact number
- Contact information for routine advice and queries
- Advice on how to self-administer misoprostol
- EMAH information leaflet
- Contraception of their choice
- Pregnancy test
- Advice about how to administer a pregnancy test
10. Discharge the patient and ensure a discharge letter has been completed.
In the case of an invalid or lost pregnancy test, women should be seen as soon as possible by Social Gynaecology.
If an on-going pregnancy is confirmed then the woman should be offered the next available date for abortion by the most appropriate method for her gestation.
If the patient does not complete their follow up plan, then her GP may be notified.