The RCOG evidence-based guideline for Male and Female Sterilisation highlighted that there is potentially a higher failure rate associated with sterilisation at the same time as abortion and that the feelings of regret associated with the procedure may be hard to predict.
Two weeks is the time period during which most women will experience complications following abortion.
- Many women experiencing complications do not go back to the clinic or to their own doctor.
- Follow-up care can be problematic because some women are embarrassed to talk to their doctors about their abortion.
- Haemorrhaging can either indicate a uterine atony (lack of normal muscle tone) or a perforation (puncture), which is a serious problem.
- It is estimated that one in 500 women, who undergo abortion in their first trimester, will have her uterus perforated.
- Symptoms of pregnancy may last a few days after the abortion.
- There are several risk factors that can predict post-abortion distress.
In one Randomised Controlled Trial (RCT) where women had requested sterilisation at the time of abortion, patients were randomised to sterilisation in combination with abortion or an interval procedure. 32.6% of women randomised to the interval procedure failed to attend, suggesting a change of mind once they had been able to distance themselves from the abortion itself.
This study emphasises the need for careful counselling at the time of sterilisation requested at the time of abortion.
Cheng MC, Cheong SC, Chew SC., "Safety of Post-abortion Sterilisation compared with Interval Sterilisation", Lancet 2, [pp.682-5].
Possible ComplicationsPostabortion complications develop as a result of three major mechanisms, as follows:
- incomplete evacuation of the uterus and uterine atony, which leads to haemorrhagic complications
- instrumental injury.
For more information on possible complications, see HERE.
Follow UpFollowing an abortion a woman may have cramps. Baths, douching and use of vaginal medication is not advised. Most women can usually return to work and resume normal activities the next day, although recovery after later abortions may take longer.
Most women will bleed off and on for a couple of weeks. The most common bleeding pattern is bleeding the day of the procedure, then not much until the fifth day after surgery, when heavier cramping and clotting occurs. Use of sanitary pads - not tampons is advised.
Abortion begins a new menstrual cycle which means ovulation will most likely occur within two to three weeks.
Abortion begins a new menstrual cycle which means ovulation will most likely occur within two to three weeks. Regular periods will commence in four to eight weeks.
It is advised that women don't have intercourse or insert anything into the vagina for at least one week after the abortion, and preferably not until they have been cleared at the follow-up appointment.
Rh NegativeThe rhesus state only matters in pregnancy if the mother is Rh-negative, the father is Rh-positive and the baby is also Rh-positive. Rh(D) positive cells contain a substance (D antigen) which can stimulate Rh(d) negative blood to produce harmful antibodies that destroy red cells. The harmful antibody is called ?anti-D' and can be produced if a mother is Rh-negative but her baby is Rh-positive.
Rhesus incompatibility doesn't occur with first pregnancies because the antibodies aren't present in the mother's blood. However, in subsequent pregnancies, if the babies are rhesus positive, there may be a problem.
An injection of Anti-D IgG (immunoglobulin) should be given to all non-sensitised RhD negative women following abortion.
It should be noted that it is fruitless to administer Anti-D IgG to RhD negative women who are found on antibody screening, already to be sensitised. Anti-D should not therefore be administered to such women as it is wasteful of Anti-D and unnecessarily exposes the women to any risks inherent in human blood products, it will not of itself, however, cause any harm to the woman.
Pregnancy Following an AbortionSymptoms of the pregnancy may last a few days following the abortion. It is important to realise that ovulation may occur within two to three weeks following the abortion and pregnancy may result.
Unplanned pregnancy within the next few months after an abortion is common as for many women there is a subconscious desire to 'replace' the pregnancy. This is especially common for women who did not really want to have the abortion but where coerced or pressured into having it.
WARNING SIGNS: LIST
- Dizziness, lightheadedness, or fainting
- Abdominal pain
- Severe cramping
- Nausea, vomiting
- Bleeding that is twice as heavy as a normal period
- Vaginal discharge that smells bad
Emotional EffectsReferral for further counselling should be available for those women who experience long term post abortion distress.
Risk factors for emotional and psychological trauma are ambivalence before the abortion, lack of a supportive partner, a psychiatric history or membership of a cultural group that considers abortion wrong.
Emotional and psychological problems following abortion can be read in greater detail here.
Read "Post Termination Information" given out to patients at a New Zealand abortion facility here.