A patient with a confirmed pregnancy who was referred to obstetrics‑gynecology but chose to obtain an abortion at a reproductive‑health clinic before the OB‑GYN appointment—what actions should the primary‑care clinician take?

Primary Care Management After Patient Self-Refers for Abortion

The primary care clinician should provide post-abortion follow-up care, contraception counseling, and ensure continuity of care without judgment, as the patient has exercised her autonomous right to obtain abortion services. 1

Immediate Actions

Respect Patient Autonomy and Provide Non-Judgmental Support

• Recognize that the patient has made an autonomous decision that aligns with her values, and your role is to support her health outcomes, not to question or reverse her choice. 1
• Practice active listening and self-reflection to ensure your personal beliefs do not impair the quality of care you provide. 1
• Avoid any directive language or actions that communicate disapproval of her decision. 1

Coordinate Post-Abortion Care

Ensure appropriate follow-up based on the abortion method:

• Medical abortion (mifepristone/misoprostol): Schedule clinical examination with ultrasound 7-14 days post-procedure to confirm complete abortion. 2
• Surgical abortion (vacuum aspiration or D&E): Clinical follow-up is only required if the patient becomes symptomatic. 2

Provide Critical Safety Education

Instruct the patient to seek immediate emergency care for:

• Soaking through 2 or more maxi pads per hour (hemorrhage warning). 2
• Fever >38°C (infection warning). 2
• Severe abdominal pain unrelieved by standard analgesia. 2
• Foul-smelling vaginal discharge (endometritis warning). 2

Verify Essential Prophylaxis Was Provided

Confirm the reproductive health clinic administered:

• Antibiotic prophylaxis to prevent post-abortal endometritis (reduces infection risk from 5-20% to 1.3%). 3, 2
• Anti-D immunoglobulin (RhoGAM) for Rh-negative patients to prevent alloimmunization—this is mandatory and must be given within 72 hours of the procedure. 3, 2, 4

If either was omitted and the patient is still within the appropriate time window, provide them immediately. 4

Contraception Counseling

Initiate Comprehensive Contraceptive Planning

Provide counseling that addresses the full range of contraceptive options, focusing on safety, effectiveness, accessibility, affordability, and acceptability. 5, 3

Key contraceptive timing principles:

• Combined hormonal contraceptives or implants can be initiated immediately without waiting for next menses. 2
• If started within 7 days of abortion, no backup contraception is needed. 2
• Long-acting reversible contraception (LARC) is highly effective and should be presented as an option using patient-centered, non-coercive counseling. 5

Address Future Pregnancy Planning

• Discuss the patient's reproductive goals and help her identify which contraceptive method best aligns with her life circumstances. 5
• If she desires future pregnancy, discuss optimal timing and any health optimization needed before conception. 5

Continuity of Primary Care

Cancel the OB-GYN Referral Appropriately

• Contact the OB-GYN office to cancel the appointment, as it is no longer needed for pregnancy management. 5
• Document in the medical record that the patient obtained abortion services elsewhere and the referral is no longer indicated.

Maintain Ongoing Primary Care Relationship

Continue to provide comprehensive primary care, recognizing that obstetrician-gynecologists and primary care physicians share responsibility for women's reproductive health counseling and services. 5

• Schedule routine well-woman care as appropriate. 6
• Address any underlying health conditions that may have influenced her pregnancy decision. 5
• Ensure she has access to preconception counseling if she desires future pregnancy. 5

Common Pitfalls to Avoid

Never Allow Personal Beliefs to Compromise Care

Healthcare providers have an ethical obligation to provide medically indicated care regardless of personal moral objections, particularly when referral might negatively affect the patient's physical or mental health. 5, 1

• Persuading the patient not to have terminated the pregnancy based on personal belief represents normalization of violence in healthcare settings. 1
• Your primary duty is to treat and provide benefit to the patient, not to impose your values. 1

Never Delay or Withhold Post-Abortion Care

• Failing to provide appropriate follow-up increases risks of undetected complications. 2
• Omitting RhoGAM in Rh-negative patients can cause alloimmunization with devastating consequences for future pregnancies. 3, 2, 4

Never Assume the Reproductive Health Clinic Provided Complete Care

• Verify that antibiotic prophylaxis and RhoGAM (if indicated) were administered. 3, 2
• Some clinics may have limited follow-up protocols, making your role in ensuring complete care essential. 5

Never Treat This Patient Differently Than Other Patients

Justice requires providing equitable care to all patients and not treating them differently simply because they obtained abortion services. 5

• Document the abortion in the medical record as you would any other medical procedure. 7
• Maintain the same standard of compassionate, comprehensive care you provide to all patients. 1