Management of patients terminating their pregnancies
Women are encouraged to attend for routine follow-up 2 weeks after operation with their General Practitioner. The purposes of the check are to:
- ensure involution of the uterus and ascertain there is no infection or retained products
- follow up any concerns about contraception
- ascertain that any emotional issues about the abortion are being resolved
Early medication abortion follow up at the Pregnancy Advisory Centre will be arranged at the time of consultation.
Very few women need further counselling following abortion if they have come to a decision for themselves. If necessary they can be referred to the Counselling Service at the Pregnancy Advisory Centre.
Variable post-operative bleeding may continue for 2 - 3 weeks. It is generally less than a period. Some women have little or no bleeding. Bleeding may not commence until several days after the operation. It usually settles spontaneously. If stop/start bleeding occurs women are encouraged to contact the Pregnancy Advisory Centre.
If bleeding appears excessive (soaking a pad every 1 - 2 hours over 3 - 4 hours) and particularly if accompanied by pain which is not relieved by adequate oral analgesia then it is likely some tissue or blood clot has been retained in the uterus. This can be managed by using a medication causing the uterus to contract and expel the remaining tissue or clot. Analgesia may be needed for the cramping pain caused by this treatment. If bleeding persists a D&C may need to be arranged to remove the tissue. This can be carried out at the PAC during regular operating sessions. At other times referral to hospital is required.
The incidence of post-abortion infection is very low. However, in women with persistent lower abdominal ache and tenderness, unusual bleeding or discharge, or unexplained fever infection should be suspected. Cervical swabs for bacterial culture and Chlamydia assay are recommended. Do not delay therapy pending swab results. Broad spectrum antibiotic treatment following current antibiotic guidelines is effective to treat suspicion of infection.
This is rare but may occur particularly when an abortion is performed at an early gestation under 6 weeks, or there is an anatomical variation of the uterus or cervix, or a twin pregnancy. For most women pregnancy symptoms subside rapidly after operation, usually 2 - 3 days, although they may be prolonged by taking the contraceptive pill. Persistent symptoms or concern about possible continuing pregnancy may require investigations with serial quantitative Beta-HCG or pelvic ultrasound scan.
Note: Urinary Beta-HCG will nearly always still be positive 2 weeks after successful abortion.