Information for professionals/referrers.
Call to consult with a peer: +31 (0)88 8884499.
Gynaikon Klinieken is a women’s clinic based on the concept of ‘from menarche to menopause’, healthcare from the first to the last menstrual period.
Mifepriston (Mifegyne®) combined with misoprostol (Cytotec®) is the treatment option that is usually chosen in the Netherlands for women who opt for the ‘abortion pill’. Up to a gestational age of 9 weeks and 0 days of amenorrhoea, women can choose between the abortion pill and suction curettage. The physician will, however, be the one who makes the ultimate decision as to whether or not a woman is suited for the abortion pill.
The gestational age will be established at the clinic through an ultrasound scan. If the woman has complied with the mandatory cooling-off period stipulated by law, she can be administered the abortion pill immediately after the consultation with the physician. This means that the woman will take Mifegyne® at the clinic and be given 4 tablets of Cytotec® for her to administer vaginally 2 days later. Mifegyne® generally causes little to no side effects. This drug is a competitive progesterone receptor blocker that ensures in 96% of cases that the products of conception stop growing. It also elevates sensitivity to prostaglandins. Cytotec® is a synthetic analog of prostaglandin E1 that triggers uterine contractions that lead to foetal expulsion.
Potential side effects include gastrointestinal discomfort, shivering, and severe blood loss. An analgesic that the woman could take is NSAID.
The abortion pill is often compared to spontaneous abortion. Medical abortion may involve more cramps and blood loss than after suction curettage.
The www.ngva.nl website contains extensive information for women about medical abortion and suction curettage.
Een zuigcurettage kan tot 12-13 weken amenorroe worden uitgevoerd. De vrouw kan kiezen tussen lokale verdoving of narcose. Voor een zuigcurettage wordt het cervicale kanaal iets gedilateerd en vervolgens wordt met een disposable kunststof curette het zwangerschapsproduct verwijderd en de baarmoeder gecuretteerd. Hierdoor is er na de ingreep doorgaans weinig bloedverlies. De behandeling duurt ongeveer 10 tot 15 minuten. Voorafgaand aan de behandeling wordt de cervix voorbereid met prostaglandines.
Heeft de vrouw gekozen voor narcose dan mag zij 24 uur niet actief deelnemen aan het verkeer.
Op de website www.ngva.nl staat uitgebreide informatie voor de vrouw over de medicamenteuze abortus en de zuigcurettage.
Dilation & Evacuation (D&E) with prostaglandin priming
If the pregnancy is further along than 12-13 weeks of amenorrhoea, the D&E procedure is used to abort the pregnancy. D&E is a method where the products of conception are removed surgically, followed by a curettage of the uterus. To create sufficient access for the surgical instruments, this procedure, too, requires priming of the cervix with prostaglandins. Gynaikon Klinieken performs this procedure up to a biparietal diameter (BPM) of 42mm.
If the woman has opted for sedation, she will not be allowed to drive a car or ride a motorcycle or bike for 24 hours.
Local anaesthetic or sedation
If a women opts for a local anaesthetic, she will get a (para)cervical block, not an epidural. If the woman is tense, the procedure may be experienced as painful.
Sedation is administered by registered anaesthetists. If the woman has undergone a procedure under sedation, she will not be allowed to drive a car or ride a motorcycle or bike for 24 hours.
Possible complications after taking an abortion pill are severe blood loss, retention of foetal tissue, and/or the pregnancy persisting.
Possible complications with a surgical procedure are uterine perforation or cervix rupture, severe blood loss, residue in the uterus (0.5%), and side effects of medication.
On average, complications occur in around 0.9% of cases. To deal with severe complications, we work together with our standby hospital. Hospital admission is required in around 0.1% to 0.2% of cases.
In general, the risk of complications is greater the further along the woman is in her pregnancy.
The woman is advised to come in for a check-up 3 weeks after the procedure. After a surgical procedure, this check-up can also be done by the referring physician if that is more convenient.
If the woman comes to you for a post-procedure check-up, an HGC urine test will generally suffice alongside the monitoring of the healing process. In case of doubt, we recommend doing a check-up ultrasound scan, for which an appointment can be made with us. The woman has been given a copy of the physician’s letter.
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