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ABORTION AFTERCARE

Care following uterine aspiration is usually straightforward, and can occur in the procedure room or recovery area. Care may vary slightly with gestational duration, type of anesthesia, and any complicating factors. Aftercare includes discharge education, observation and support depending on analgesia administered, surveillance for immediate and delayed complications, review of any instructions, and/or referral for a contraceptive method if desired.

Recovery and Monitoring

Clinician or other staff should assess the following parameters prior to discharge:

  • Adequate pain control
  • Level of alertness and normal oxygen saturation if IV sedation was used
  • Vaginal bleeding controlled and stable
  • Normal stable vital signs
  • Ability to ambulate independently

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

  • NSAID and/or additional pain medications
  • Preferred contraceptive method, if desired, including offer of condoms and emergency contraception

Most people require only 15 – 30 minutes of recovery time, including those receiving local anesthesia, oral or short-acting IV sedation. People should not drive after sedating medications. Rideshare or taxi may be considered in some health centers (See Ch 5: Logistical Considerations for Sedation).

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 person to take with them.Though many clinicians advise people to limit their activity after abortion, there is no credible evidence of harm for activity/use of vagina after abortion except evidence of harm with douching (Cottrell 2003).

Aftercare for Procedures Performed Elsewhere

Many people have limited local access to abortion or early pregnancy loss (EPL) care and may arrive at health centers, primary care offices, emergency departments, and urgent care centers seeking follow-up care for care provided elsewhere or a self-managed medication abortion. Whether or not the person experienced abortion or EPL will not change medical evaluation or management. Avoid asking clinically unnecessary questions or documenting whether they used medications or accessed abortion care. This will minimize harm in the setting of restrictive laws and criminalization of pregnancy and abortion. Avoid non-emergency referrals which will incur costs, potentially lead to unnecessary procedures and interventions, and increase risk of criminalization.

Medical evaluation should include a physical exam, as needed, including

  • Vital signs +/- labs if symptoms of hypovolemia or heavy bleeding (including orthostatics and hemoglobin / hematocrit)
  • Abdominal examination (to rule out peritonitis or other causes for symptoms)
  • Pelvic examination (for bleeding, cervical dilatation, tenderness, vaginal or cervical trauma, or evidence of infection such as mucopurulent cervical discharge)
  • If present, tissue examination (for clot vs. pregnancy tissue).

Ultrasound examination after either abortion or EPL often shows non-specific heterogeneous intrauterine debris. If seen or shown on an US report, inform that this is a normal finding and not a complication.The decision to intervene should be based on clinical presentation (ongoing bleeding, pain and / or signs of infection) and not just US appearance.

If a hemodynamically stable patient is experiencing ongoing bleeding and / or pain, management options include: expectant management (“watch and wait”), medication management (with misoprostol), or uterine aspiration, each with appropriate pain management. If the person is hemodynamically unstable, proceed with uterine aspiration.

If a hemodynamically stable patient has findings concerning for infection, initiate antibiotics and consider uterine aspiration with close follow up. Antibiotic choice should cover N. gonorrhoeae and C. trachomatis as well as anaerobes (e.g. ceftriaxone 1g IM once + doxycycline 100 mg PO BID x14 days + metronidazole 500mg PO BID x14 days, CDC 2021). If the person is hemodynamically unstable, consider inpatient management with laboratory work up and administration of IV antibiotics, fluids, and, if necessary, blood products.

Follow Up Visits And Referrals

While some patients may have specific indications for a follow-up visit, data does not support routine visits after uterine aspiration (Gatter 2014, Grossman 2004, NAF 2024). Most people 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
  • Concern for infection with fever/chills, abdominal pain, vaginal discharge (see above)
  • Needed re-evaluation (e.g. serial hCGs for PUL or suspected GTD)
  • Need for follow-up contraceptive or medical visit (e.g. unable to place IUD on day of procedure, BP for possible hypertension)
  • Medical, social, or emotional needs identified during abortion care

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

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

Most people do not regret their decision to have an abortion, or have related mental health issues (Biggs 2016, Horvath 2017), although it can be difficult to deal with stigma, lack of support, or isolation a person may experience.

Many people respond well to encouragements of artistic expression, through writing, visual art, or music. Consider providing a journal in the health center where people can share their thoughts or art. If desired, people can read, hear or share stories through sites such as shoutyourabortion.com or wetestify.org.

All people can be offered post-abortion support through:

License

TEACH Abortion Training Curriculum 8th Edition Copyright © by The TEACH Program. All Rights Reserved.

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