What are the red flags to watch out for after an induced abortion (Induced Termination of Pregnancy, ITP)?

From the Guidelines

After an induced abortion, it is crucial to watch for red flags such as heavy bleeding, severe abdominal pain, fever, foul-smelling vaginal discharge, and signs of continuing pregnancy, and seek immediate medical attention if these symptoms occur. These red flags can indicate complications such as infection, hemorrhage, or incomplete abortion, which can significantly impact morbidity, mortality, and quality of life if not addressed promptly. Some key symptoms to watch out for include:

• Heavy bleeding, defined as soaking through two or more pads per hour for two consecutive hours
• Severe abdominal pain that is not relieved by medication
• Fever of 100.4°F (38°C) or higher
• Foul-smelling vaginal discharge
• Signs of continuing pregnancy, such as persistent nausea or breast tenderness Other concerning symptoms include feeling faint or dizzy, rapid heartbeat, delayed bleeding that starts or increases after initially decreasing, or emotional distress that interferes with daily activities 1. Most women experience moderate bleeding similar to a heavy period for 1-2 weeks, mild cramping, and some emotional responses, which are normal. It is essential to take prescribed medications as directed, including antibiotics if provided, and pain relievers like ibuprofen (600-800mg every 6 hours) for cramping, and to rest for 24-48 hours after the procedure, avoid tampons and sexual activity for two weeks to prevent infection, and attend the follow-up appointment to ensure complete abortion and recovery 1. These precautions help identify potential complications early when treatment is most effective, thereby reducing the risk of morbidity, mortality, and improving quality of life. In the event of any concerning symptoms, it is vital to seek immediate medical attention to prevent long-term consequences and ensure the best possible outcome.

From the FDA Drug Label

MISOPROSTOL ADMINISTRATION TO WOMEN WHO ARE PREGNANT CAN CAUSE BIRTH DEFECTS, ABORTION, PREMATURE BIRTH OR UTERINE RUPTURE. UTERINE RUPTURE HAS BEEN REPORTED WHEN MISOPROSTOL WAS ADMINISTERED IN PREGNANT WOMEN TO INDUCE LABOR OR TO INDUCE ABORTION THE RISK OF UTERINE RUPTURE INCREASES WITH ADVANCING GESTATIONAL AGES AND WITH PRIOR UTERINE SURGERY, INCLUDING CESAREAN DELIVERY A major adverse effect of the obstetrical use of Cytotec is the hyperstimulation of the uterus which may progress to uterine tetany with marked impairment of uteroplacental blood flow, uterine rupture (requiring surgical repair, hysterectomy, and/or salpingo-oophorectomy), or amniotic fluid embolism Pelvic pain, retained placenta, severe genital bleeding, shock, fetal bradycardia, and fetal and maternal death have been reported.

After an induced abortion, the things to watch out for as red flags are:

• Uterine rupture: increased risk with advancing gestational ages and prior uterine surgery, including Cesarean delivery 2
• Hyperstimulation of the uterus: may progress to uterine tetany, uterine rupture, or amniotic fluid embolism 3
• Severe genital bleeding
• Shock
• Fetal bradycardia
• Fetal and maternal death
• Pelvic pain
• Retained placenta

From the Research

Red Flags After Induced Abortion

After an induced abortion, there are several red flags to watch out for, including:

• Serious infection, which can be life-threatening 4
• Upper genital tract infection, which is relatively uncommon but can occur 5
• Clostridial infections, which can be fatal if not recognized and treated promptly 4
• Significant risk of upper genital tract infection if Chlamydia trachomatis, Neisseria gonorrhoeae, or acute cervicitis is present 5
• Elevated risk of post-procedural infection in women with bacterial vaginosis (BV) 5

Signs and Symptoms of Infection

Signs and symptoms of infection after induced abortion may include:

• Fever
• Chills
• Pelvic pain
• Abnormal vaginal discharge
• Heavy bleeding

Prevention and Treatment of Infection

To prevent and treat infection after induced abortion:

• Prophylactic antibiotics, such as doxycycline, may be prescribed before surgical abortion 5
• Treatment-dose antibiotics may be prescribed for medical abortion to lower the risk of serious infection 5, 6
• Routine provision of antibiotics after medical abortion may reduce the risk of serious infection 6, 7

Other Complications

Other complications that may occur after induced abortion include:

• Pain, which can be managed with analgesics such as ibuprofen 8
• Gastrointestinal side effects, such as nausea and vomiting 7, 8
• Unscheduled contact with the care provider due to pain or other complications 8