From the Guidelines
After a medication abortion, it is crucial to prioritize follow-up care to ensure the abortion is complete and to address any potential complications, while also considering the latest guidelines on RhD testing and RhIg administration, which suggest that these procedures should not pose barriers to accessing abortion care. When considering aftercare for medication abortion, several key points must be addressed to minimize morbidity, mortality, and maximize quality of life.
- Expect bleeding and cramping for 1-2 weeks, with the heaviest bleeding occurring within the first 24 hours, as part of the normal process after a medication abortion 1.
- For pain management, take ibuprofen (600-800mg every 6-8 hours) or acetaminophen (650mg every 4-6 hours) as needed, following the recommended dosages to alleviate discomfort without risking overdose.
- Use pads rather than tampons for the first week to reduce the risk of infection, a precaution that is generally recommended for post-abortion care.
- Rest for 24-48 hours and avoid strenuous activity for about a week to allow the body to recover from the procedure.
- Abstain from sexual intercourse for at least 7 days or until bleeding stops to minimize the risk of infection.
- Be aware of warning signs that require immediate medical attention, such as soaking through more than two maxi pads per hour for two consecutive hours, severe pain unrelieved by medication, fever over 100.4°F (38°C), foul-smelling vaginal discharge, or continued pregnancy symptoms after 2 weeks, as these could indicate complications.
- A follow-up appointment 1-2 weeks after the procedure is recommended to confirm the abortion is complete, which is a critical step in ensuring that the process has been successful and that there are no lingering health issues.
- Most people can resume normal activities within a few days, though your period should return within 4-8 weeks, marking a return to pre-pregnancy hormonal balance.
- Emotional responses vary widely after abortion, so seeking support if needed is important for mental health and well-being. Considering the latest statement from the Society for Maternal-Fetal Medicine 1, it's clear that access to abortion care, including medication abortion, should be prioritized without unnecessary barriers, including those related to RhD testing and RhIg administration, to ensure that individuals can safely and effectively terminate pregnancies without undue delay or risk.
From the Research
Medication Abortion After Care
- The efficacy, benefits, and limitations of available and emerging follow-up options for medication abortion have been assessed, indicating that medication abortion follow-up does not have to be a 'one size fits all' protocol 2.
- Follow-up options include facility-based ultrasound, laboratory-based repeat serum beta-human chorionic gonadotropin (hCG) testing, urine hCG testing, self-assessment with symptom evaluation, and no intervention 2.
- Remote, client-led follow-up options, such as urine pregnancy testing and symptoms evaluation, are well tolerated and effective for ruling out the rare outcome of ongoing pregnancy after medication abortion 2.
- Guidelines from several professional organizations have aligned with the evidence and no longer recommend routine office-based follow-up, instead suggesting that providers offer follow-up options that align with the comfort, logistical ability, and values of the client 2.
Effectiveness and Safety of Medication Abortion
- Studies have shown that medication abortion is highly effective, with success rates ranging from 94.0% to 95.8% 3.
- Adverse events are low, with rates of 2.1% for emergency department visits, 4.7% for clinically significant retained products of conception, 0.4% for heavy bleeding requiring treatment, 1.2% for ongoing pregnancy, and 0.2% for ectopic pregnancy management 3.
- History-based screening for medication abortion eligibility has been shown to be effective and safe, with an adjusted effectiveness rate of 94.8% and low rates of major abortion-related adverse events 4.
Client-Centered Care
- Providers should offer follow-up options that align with the comfort, logistical ability, and values of the client, ensuring that care is person-centered 2.
- Client-led follow-up options, such as urine pregnancy testing and symptoms evaluation, can be effective and well tolerated, and may facilitate more equitable access to abortion care 2, 4.
- The use of low- and no-test medication abortion protocols can be individualized, allowing for more flexible and accessible care 3.