Postabortion care
Rhesus prophylaxis
Anti-D immunoglobulin should be given to the deltoid muscle to rhesus D-negative women within 72 hours following surgical abortion or medical abortion after 10 weeks of gestation to prevent sensitization.
The recommended dose is 250 IU for abortions before 20 weeks, and 500 IU thereafter. After abortions beyond 20 weeks of gestation, the Kleihauer test is recommended to assess the size of fetal-maternal haemorrhage, and if this is more than 4 mL, an additional dose of 125 IU∕mL should be given (25). It may be noted that because of lack of good evidence, rhesus testing or anti-D prophylaxis is not recommended for medical abortion before 10 weeks of gestation by the new UK NICE Guideline (2019).Information to the client
Upon discharge from the abortion facility, the women should be given instructions on the expected side effects and when to seek further medical assessment. This should include symptoms of complications which should necessitate urgent medical attention, as well as symptoms of continued pregnancy for which further management should be sought. A written document stating the treatment procedure received would facilitate the seeking of management from other healthcare providers for any complications arising from the abortion. A plan of future contraception should be discussed and formulated before discharge from the abortion service. Information on long- acting reversible contraceptive methods should be provided.
Postabortion contraception
A full range of contraceptive methods should be available at the abortion service and provided immediately after abortion if applicable. An intrauterine contraceptive device can be inserted immediately after induced abortion as long as continued pregnancy is reasonably excluded; delaying the insertion to a later time has been shown to reduce uptake of the method (26, 27).
If the insertion has to be delayed, an effective interim method should be provided. Hormonal contraceptives can be started right after the abortion (28, 29). Female sterilization can be safely performed at the same time following the induced abortion unless there is a serious complication such as sepsis, severe haemorrhage, or genital tract trauma. However, a higher risk of regret and failure may be the result (3, 29).Follow-up care
Routine follow-up is not mandatory after surgical abortion or medical abortion where mifepristone has been used (3, 8). However, a follow-up visit can be arranged if complete abortion cannot be ascertained, or if the woman has any concern about incomplete abortion or has other issues to discuss with the healthcare personnel.
During the follow-up visit, the healthcare worker needs to assess for complications from the abortion procedure, including symptoms and signs of failed or incomplete abortion and infective complications. An ultrasound scan should not be routinely performed at follow-up. Interventions to manage incomplete abortions should be decided based on clinical signs and symptoms, but not on ultrasound findings. The sonographic presence of intrauterine material correlates poorly with subsequent symptoms of incomplete abortion, and this need not be acted upon if the woman is asymptomatic; most of them can resolve spontaneously without clinical sequelae (30-32). The main indication for a pelvic ultrasound examination is to exclude the possibility of an ongoing pregnancy.
Besides, a proper ongoing contraceptive plan should be reinforced. Compliance and problems with contraceptive use should be assessed. Women engaged in high-risk sexual behaviours should be counselled on safe sex. For those diagnosed with a sexually transmitted infection, proper treatment as well as contact tracing, screening, and∕or treatment of partners should be assured. Psychological morbidities such as emotional problems, guilt, or regret, as well as social problems, should be attended to as well.