Surgical abortion care

Care before a surgical abortion

Before a surgical abortion, your health professional will:

• Evaluate your medical history, including any medicines you are taking.
• Do a physical examination, including a pelvic examination, to evaluate your health, how long you have been pregnant, and the location and health of the embryo or fetus.
• Perform an ultrasound to confirm how far along and where the pregnancy is. Not all health professionals choose to do this step.
• Discuss your decision to have an abortion and your feelings about the decision.
• Discuss your plans for future pregnancies and birth control use.
• Explain the procedure, possible problems, and when to call your health professional.

Care immediately after a surgical abortion

After a surgical abortion procedure, your health professional will check to make sure:¹

• Your vital signs such as heart rate, breathing, and blood pressure are normal.
• Bleeding is not excessive.
• Uterine contractions are normal.
• Side effects from anesthetic (local or general) are not causing problems.

Medicines that may be given after a surgical abortion include:¹

• Antibiotics, to prevent infection.
• Medicines that cause uterine contractions (uterotonic), to empty the uterus completely and reduce bleeding.
• Rh immune globulin, which is given to all women who have Rh-negative blood type to prevent Rh sensitization after the procedure.
• Pain medicine, for cramping pain caused by uterine contractions.
• Medicine to treat nausea or vomiting.

Care at home after a surgical abortion

Carefully follow all of your health professional's instructions and review what-to-expect information after a surgical abortion. Follow these instructions:

• Most women can return to normal activities in 1 to 2 days after the procedure. Avoid strenuous exercise for about 1 week.
• Do not have sexual intercourse for at least 1 week, or longer, as advised by your health professional.
• When you start having intercourse again, use birth control, and use condoms to prevent infection. For immediately effective birth control, you can use a barrier method (such as a diaphragm, cervical cap, or condom). An intrauterine device (IUD) is effective immediately after it is placed in the uterus. If you start hormone birth control pills, patches, or injections right after the procedure, be sure to use a backup method until the hormone medicine becomes effective. For more information, see the topic Birth Control.
• Do not rinse the vagina with fluids (douche). This could increase your risk of infections that can lead to pelvic inflammatory disease.

Normal symptoms that most women will experience after a surgical abortion include:

• Irregular bleeding or spotting for the first 2 weeks.
• Cramping for the first 2 weeks. Some women may have menstrual-like cramping for as long as 6 weeks.
• Emotional reactions for 2 to 3 weeks.

Less than 1% of all women who have an abortion have serious problems afterward.²

Signs of complications

Call your health professional immediately if you have any of these symptoms after an abortion:

• Severe bleeding. Both medical and surgical abortions usually cause bleeding that is different from a normal menstrual period. Severe bleeding can mean:
  • Passing clots that are bigger than a golf ball, lasting 2 or more hours.
  • Soaking more than 2 large sanitary pads in an hour, for 2 hours in a row.
  • Bleeding heavily for 12 hours in a row.
• Signs of infection in your whole body, such as headache, muscle aches, dizziness, or a general feeling of illness. Severe infection is possible without fever.
• Severe pain in the abdomen that is not relieved by pain medicine, rest, or heat
• Hot flushes or a fever of 100.4F or higher that lasts longer than 4 hours
• Vomiting lasting more than 4 to 6 hours
• Sudden abdominal swelling or rapid heart rate
• Vaginal discharge that has increased in amount or smells bad
• Pain, swelling, or redness in the genital area

Call your health professional for an appointment if you have had any of these symptoms after a recent abortion:

• Bleeding (not spotting) for longer than 2 weeks
• New, unexplained symptoms that may be caused by medicines used in your treatment
• No menstrual period within 6 weeks after the procedure
• Signs and symptoms of depression. Hormonal changes after a pregnancy can cause postpartum depression that requires treatment.

Asherman's syndrome is a complication that occurs rarely after a surgical abortion done with dilation and curettage (D&C). Asherman's syndrome involves scarring in the uterus and narrowing in the cervix that can, but rarely does, affect your ability to become pregnant in the future.¹

Follow-up exam after a surgical abortion

A follow-up exam may be done 2 to 3 weeks after a surgical abortion. The exam may include:¹

• A physical exam, to check the cervix and uterus.
• A lab test to check for a low human chorionic gonadotropin (hCG) level, which means that the pregnancy has ended.
• A blood test, to check for anemia.
• A discussion of birth control use. If birth control measures were started immediately after the abortion procedure, the proper use of the method can be discussed again. If you have had an intrauterine device (IUD) inserted at the time of the abortion procedure, you can discuss any questions you have with your health professional.

Citations

1. Paul M, et al. (1999). A Clinician's Guide to Medical and Surgical Abortion. New York: Churchill Livingstone.

2. Facts on induced abortion in the United States (2006). In Brief. New York: Alan Guttmacher Institute. Also available online: http://www.guttmacher.org/pubs/fb_induced_abortion.html.