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, and surveillance for immediate and delayed complications. Post-procedure care includes reviewing any instructions or referrals for the contraceptive method chosen by the patient.
RECOVERY AND MONITORING:
Provider or staff should assess the following parameters prior to discharge:
- Adequate pain control
- Stable, controlled vaginal bleeding
- Normal, stable vital signs
- Normal oxygen saturation
- Ability to ambulate independently
- If IV sedation used, consider using validated score (i.e. Aldrete) to assess alertness
The following discharge medications are given or reviewed for home use:
- NSAID use and any additional pain medications
- If applicable, preferred contraceptive method, including offering condoms and EC
Most patients require only 15-30 minutes of recovery time, including those receiving local anesthesia, NSAIDs, oral opioids or anxiolytics, or short-acting IV sedation. With any sedating medications, a patient should not drive, and should be discharged to the care of a person who will escort them home.
Discharge education should include anticipatory guidance for telling the difference between normal symptoms from warning signs for complications, and instructions should they occur (see below). As patients receiving IV sedation may not recall instructions given after sedation, review instructions prior to sedation and have written materials for the patient to take with them.
While some patients may have specific indications for a follow-up visit, data do 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 either a routine follow-up visit, but specific indications for one include:
- Suspected incomplete abortion, ongoing pregnancy or ectopic pregnancy
- Need for follow-up contraceptive visit (i.e. BP check for elevated blood pressure, unable to place IUD on day of procedure)
A patient may have 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.
ABORTION PROCEDURE AFTERCARE
Adapted from RHAP & RRWC MVA AFTER-CARE INSTRUCTIONS
Today you had an abortion procedure. You will most likely feel fine when you go home. You can return to your normal activities as soon as you want. You can take a shower and wash your hair as soon as you want. You can eat normally, but you may still feel nauseated for a couple days.
Are there things you should not do? Yes. For one week, do not use tampons and do not douche. You may or may not feel like being intimate or having vaginal intercourse during this time. It is good to trust your body and resume intercourse when you feel ready.
WHAT TO EXPECT
Vaginal Bleeding: You can expect to have bleeding for up to 2 weeks. It is common for the bleeding to stop and start for a few weeks after the abortion. Some people have no bleeding for 2 or 3 days and then begin to have bleeding like a period. Other people have only spotting for a few days and then no bleeding at all. You may notice that the bleeding increases when you exercise; this is not dangerous.
Cramping: You may have cramps off and on during the week following an abortion. You can use pain medication like Tylenol, Ibuprofen (Motrin or Advil), or Naproxen (Aleve or Naprosyn). You can also use a heating pad or drink some warm tea.
Sadness or mood changes: You may feel relieved when the abortion is over. You may also feel sad or moody. These feelings are may be due to hormonal changes, now that you are no longer pregnant. Feeling moody at this time is normal. If you think your emotions are not what they should be, please talk to us.
When will your period come back? You can expect a period in 4 to 8 weeks. This varies.
If you want to use birth control pills, the patch, or the ring, I have given you a prescription. You should start these on ____________________, even if you are still bleeding.
Most patients feel better in the month following an abortion or miscarriage. If you are in need of additional support, call us, or consider contacting one of the following hotlines, which help answer questions and provide you with additional support: www.exhaleprovoice.org or 866-4EXHALE, www.alloptions.org or 888-493-0092, or www.connectandbreathe.org or 866.647.1764.