Purpose
Comprehensive postabortion care services should include both medical and preventive
health care. The objectives of postabortion care are to provide:
- Emergency treatment of incomplete abortion and potentially life-threatening
complications
- Postabortion family planning counseling and services
- Links between postabortion emergency services and the reproductive health care system
Emergency Treatment
Emergency treatment for postabortion complications includes:
- Initial screening (vital signs, temperature and amount of bleeding) to assess the
patient’s condition
- Talking to the woman regarding her medical condition and the treatment plan
- Medical assessment (brief history, limited physical and pelvic examinations)
- Stabilization of emergency conditions (shock, hemorrhage or sepsis)
- Prompt referral and transfer if the woman requires treatment beyond the ability of the
facility where she is seen
- Uterine evacuation to remove retained products of conception
The prompt treatment of postabortion complications is an important part of obstetric
care that should be available at every district-level hospital. In addition, through the
use of manual vacuum aspiration (MVA), treatment of uncomplicated, incomplete
abortion can be provided even at the primary care level, including most family planning
clinics.
Why MVA?
MVA is the preferred method of uterine evacuation to treat incomplete abortion because
relative to traditional treatment (D&C):
- the risk of complications is decreased,
- access to services is increased, and
- the cost of postabortion services is reduced.
In addition, use of MVA offers the potential for earlier access to care, when
management is easier and serious complications less likely.
Postabortion Family Planning
In many instances, provision of emergency postabortion care may be one of the few
occasions that a woman and her partner come into contact with the health care system.
Therefore, it represents an important opportunity for providing contraceptive information
and services.
Postabortion family planning should include the following components of good family
planning:
- Counseling about contraceptive needs in terms of the client’s reproductive goals
- Information and counseling about all available methods, their characteristics,
effectiveness and side effects
- Choices among methods (e.g., short- and long-term, hormonal and nonhormonal)
- Assurance of contraceptive resupply
- Access to followup care
- Information about the need for protection against STDs
Postabortion family planning also should be based on an individual assessment of each
woman’s situation:
- her personal characteristics,
- clinical condition, and
- the service delivery capabilities in the community where she lives.
When to Start Family Planning
Postabortion family planning services need to be initiated immediately because
ovulation may occur as early as 11 days following treatment of the incomplete abortion and
usually occurs before the first menstrual bleeding. At a minimum, all women receiving
postabortion care need counseling and information to ensure that they
understand:
- they can become pregnant again before the next menses,
- there are safe contraceptive methods to prevent or delay pregnancy, and
- where and how they can obtain family planning services and methods.
Which Contraceptive Methods Can Be
Used
All modern methods of contraception are appropriate for use after treatment for
incomplete abortion as long as the provider:
- screens the woman for the standard precautions for use of a particular method, and
- gives adequate counseling.
Information on the provision of postabortion contraception, including indications and
precautions for specific methods, is provided in the section of this manual pertaining to
each contraceptive method.
Links to The Reproductive
Health Services
It is important to identify any other reproductive health services that a woman may
need following an incomplete abortion and to offer her as wide a range of services as
possible. For example:
- Some women may want to become pregnant soon after having an incomplete abortion, barring
any medical reasons.
- For women over age 30–35, it may be possible to offer cervical cancer screening at
the time of treatment or to provide referral to a facility where screening is available.
- Some women may need treatment for STDs. (Providers should be alert to any symptoms).
 
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