ABORTION AFTERCARE

Care of patients following uterine aspiration is usually straightforward, and can occur in a recovery area or procedure room. Care may vary slightly with gestational age of the pregnancy, type of anesthesia, and any complicating factors. Post-aspiration care includes discharge education, observation and support related to analgesia administered, surveillance for immediate and delayed complications, and review of any instructions or referrals for any contraceptive method chosen by the patient.

RECOVERY AND MONITORING

Provider or staff should assess the following parameters prior to discharge:

• Adequate pain control
• Controlled stable vaginal bleeding
• Normal stable vital signs
• Normal oxygen saturation if sedation is used
• Ability to ambulate independently
• Alertness (i.e. Aldrete score) if IV sedation used

The following discharge medications may be given or reviewed for home use:

• NSAID and / or any additional pain medications
• Preferred contraceptive method, if applicable, including offering condoms and EC

Most patients require only 15-30 minutes of recovery time, including those receiving local anesthesia, NSAIDs, oral opioids / anxiolytics, or short-acting IV sedation. A patient should not drive after sedating medications. Sedation may still be provided with or without an escort as long as the patient does not drive themselves.

Discharge education should include guidance for deciphering normal symptoms from warning signs, and instructions should such symptoms occur (see below). Review instructions prior to sedation or after it has worn off, and have written materials for the patient to take with them.

While some patients may have specific indications for a follow-up visit, data does not support routine visits after uterine aspiration (Grossman 2004). Most patients can be given aftercare instructions and a phone number to call with concerns in lieu of a routine follow-up visit, but specific indications for a follow-up visit include:

• Suspected incomplete abortion, ongoing pregnancy or ectopic pregnancy
• Need for re-evaluation or follow-up (e.g. serial hCGs)
• Need for follow-up contraceptive visit (e.g. unable to place IUD on day of procedure, BP check for elevated blood pressure)
• Medical, social, or emotional needs identified during their abortion care.

Offer to be available, but also give reliable referral information to respectful providers and facilitate care, including to:

• Support hotlines
• Primary and specialty medical care, including prenatal or fertility services.
• Mental health, behavioral health, intimate partner violence, or substance use counseling
• Social needs such as food, housing, etc.