• Consultation as per normal referral at the clinic visit.
• Patient will be risk assessed and MUST fit the inclusion criteria.
• The consent form will be signed and stored in the casenotes.
• Bloods will be taken for G+S and FBC.
• Patient will be given the Early Discharge information leaflet (appendix 1).
• The follow up pregnancy test information (appendix 1) will be given in conjunction with a pregnancy test.
• If the pregnancy test result shows “risk of termination failure” then the patient should contact Sandyford.

• Ensure appropriate documentation is available.
• Check consent form is signed.
• Ensure intra-uterine pregnancy is confirmed by ultrasound scan.
• Check paperwork in the ICP.
• Check the patient is sure of their decision.
• Mifepristone 200mg PO will be administered in the gynaecology day ward (except when the patient has been given this at the clinic).
• Advise patient to return to the ward if she vomits within 1 hour.
• Ensure advice is given to the patient regarding pain and/or bleeding they may experience over the following 24-48 hours.
• Ensure the patient has the ward telephone number.
• Relevant information should be documented in the ICP.

48 hours following mifepristone.

• Arrive patient under ward attenders on Trakcare.
• Nurse enquires about pain/bleeding/passage of products of conception.
• Check BP, pulse and temperature.
• Explain the procedure to the patient including information about expected PV bleeding/ abdominal pain/ passage of tissue.
• Patient is NOT routinely required to fast.
• Misoprostol 800mcg is administered PV (this may be self administered.)
• Metronidazole 1g is administered PR (this may be self administered.)
• Diclofenac 100mg is administered PR as prophylactic analgesia unless contraindicated (this may be self administered.)
• Anti-D prophylaxis MUST be given to ALL rhesus negative women.
• Give prescribed contraception – COCP, POP, implant or Depo-provera prior to discharge. If the patient requires an IUCD or IUS they should attend Sandyford or their GP after their pregnancy test has established they are not pregnant.
• Azithromycin 1g PO.
• Discharge analgesia should be offered.
• Ensure the patient has a pregnancy test to do in 2 weeks time.
• Relevant information should be documented in the ICP.
• Outcome patient under ward attenders on Trakcare.
• Ensure the patient has contact phone numbers and advise them that they may telephone the ward today and then Sandyford with any queries/problems.

The patient will have been advised to do a pregnancy test 2 weeks after being administered misoprostol. They will be informed to contact Sandyford if the result states “there is a risk of termination failure” or if they have any concerns.

What to Expect at Home