ROUTINE POST-ABORTION CARE

 

Care of patients following uterine aspiration is usually straightforward and can occur in an exam room where the procedure was done or a recovery room. Care may vary slightly with the gestational age of the pregnancy, the 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. A critical component of post-procedure care is initiation of the contraceptive 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 if IV sedation was used
  • Ability to ambulate independently

The following discharge medications are given or reviewed for home use:

  • Prophylactic antibiotics
  • NSAIDs
  • Preferred contraceptive method, including condoms and emergency contraception

Most patients require only 20-30 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 deciphering normal symptoms from warning signs for complications and instructions should they occur (see below). Contraceptive methods can be placed, dispensed or prescribed on the procedure day.

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
  • Additional contraceptive reinforcement
  • Further counseling or concerns

WHAT TO EXPECT AFTER AN ABORTION or MISCARRIAGE

Adapted from RHAP & RHEDI MVA AFTER-CARE INSTRUCTIONS

Following an aspiration abortion, you will likely feel fine when you go home. Any nausea you feel should go away within the next day.

WHEN CAN YOU RETURN TO YOUR NORMAL ACTIVITIES?
Starting right away, you can resume most of your normal activities.  You can eat as you would normally, and shower as soon as you’d like. Listen to your body when it comes to heavier exercise. You can resume sexual activity whenever you are ready. Because you can get pregnant right away, it is important that you start your chosen method of birth control as discussed.

Be sure to fill any prescriptions you may have been given for antibiotics, birth control or other medicine and take them as instructed.

WHAT TO EXPECT
Vaginal Bleeding: You can expect to have bleeding for up to 2 weeks. Some patients have bleeding that starts and stops, some patients have no bleeding for a few days followed by bleeding like a period, and others have only spotting.

Cramping: Some patients have cramps off and on during the week. You can use a heating pad or pain medication like Ibuprofen, Naproxen, or Acetaminophen.

Sadness or feeling very emotional: Most patients feel very relieved when the abortion is over. Some patients also feel sad, feel like crying, or are moody after an abortion. Feeling emotional at this time is normal. If you think your emotions are not what they should be, please contact the clinic and/or return for follow-up.

When will menses resume? You can expect a period in 4-8 weeks. It is not the same for all patients or with all contraceptive methods.

Call if any of the following warning signs occur:

  • Bleeding that soaks through more than 2 maxi pads per hour for more than 2 hours.
  • Cramps that are getting stronger and are not helped by pain medication.
  • Temperature higher than 101 degrees.

To reach the clinic: Here is a 24-hour contact number: _____________________. If you have any questions, think something is wrong, or think you are having an emergency, please call this number; if you do not reach someone right away, you will be called back within 10-15 minutes. We know that this may be a tough time for you, so if you forget something or are worried, please do not hesitate to call.

PREGNANCY PREVENTION

You can get pregnant before your period returns, so it is important to start your chosen method of birth control today if possible. For most forms of birth control, you will need to use a back up method such as a condom for the next week. If you have sex without protection during this time, you can use Emergency Contraception (EC) to decrease the chance of another pregnancy. The clinic staff can give you EC or a prescription for EC before you leave today, or you can always return for this if needed.

ADDITIONAL SUPPORT

Most patients feel better in the month following an abortion, and studies show both mood and quality of life improve.  If you are in need of additional support, consider contacting one of the following national hotlines, which help answer questions and address emotional wellbeing following abortion: www.exhaleprovoice.org or 866-4EXHALE, www.yourbackline.org 888-493-0092, or www.connectandbreathe.org, 866.647.1764.

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