Medical Abortion Care

Topic Overview

A medical abortion is the use of medicines to end a pregnancy. Medical care for a medical abortion is different from medical care for a surgical abortion. This is because a medical abortion is like a miscarriage (in this case, caused by medicines) that takes place at home over 1 to 2 days and does not require your doctor to be present. After a couple of weeks of bleeding, you then see your doctor for a follow-up examination.

Care before a medical abortion

Before a medical abortion, your doctor may:

• Evaluate your medical history, including any medicines you are taking.
• Do a physical exam, including a pelvic examination, to evaluate your health, how long you have been pregnant, and location of the embryo or fetus.
• Perform an ultrasound to confirm how far along and where the pregnancy is. Not all doctors 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 how the medicines will work, possible side effects (nausea, vomiting, and diarrhea are common), and when to call your doctor. It is important for your doctor to know whether you:
  • Have access to a telephone, to call if you have problems.
  • Have transportation to a health care facility if you need to be evaluated.
  • Will be able to return for a follow-up appointment.
  • Are prepared for the cramping pain and bleeding that will occur as the uterine contents are passed.
  • Understand that a surgical abortion will be needed if a medical abortion fails to complete the process.

In addition to the medicines used to cause an abortion, your doctor will give you medicines to minimize side effects, with specific instructions for their use. These medicines are used:

• For cramping pain caused by uterine contractions.
• To prevent nausea or vomiting.
• To prevent infection.

All women who have Rh-negative blood type will be given Rh immunoglobulin to prevent Rh sensitization after an abortion.

If you need to call your doctor about your symptoms during a medical abortion, be prepared to provide information about:

• How heavy the bleeding is, compared with your normal menstrual bleeding. The heaviest bleeding should stop 1 to 2 hours after passing the pregnancy tissue.
• The number and types of pads used in 1 hour and the total number of soaked pads used.
• The presence and size of blood clots.
• Whether any pregnancy tissue has been passed.
• The severity of your cramping or pain.

Care after a medical abortion

Carefully follow all of your doctor's instructions and review what-to-expect information after a medical abortion.

Follow these instructions:

• Most women can return to normal activities in 1 to 2 days after the uterus has cleared. Avoid strenuous exercise for 1 to 2 weeks.
• Do not have sexual intercourse for 1 to 2 weeks or as advised by your doctor.
• Be sure to use birth control when you start having sex again. And use condoms to prevent infection. 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 medical abortion include:

• Bleeding or spotting for up to 14 days. Bleeding may last longer for pregnancies of more than 7 weeks.
• Cramping for the first 2 weeks. Some women may have cramping (like menstrual cramps) for as long as 6 weeks.
• Emotional reactions for 2 to 3 weeks, often influenced by changes in pregnancy hormones. It's normal to feel one or more emotions such as relief, guilt, sadness, and/or grief.

Call your doctor 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 belly that is not relieved by pain medicine, rest, or heat
• Hot flushes or a fever of 100.4°F (38°C) or higher that lasts longer than 4 hours
• Vomiting lasting more than 4 to 6 hours
• Sudden belly 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 doctor for an appointment if you have had any of these symptoms after a recent abortion:

• No bleeding. If bleeding does not occur, then the medicines may not be working. A second dose of misoprostol may be needed. Methotrexate and misoprostol may take up to 3 weeks to be effective.
• 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 depression that requires treatment.

Complications that can occur include:

• Tissue remaining in the uterus (retained products of conception). Cramping belly pain and bleeding will occur again within a week of the procedure.
• Infection. Symptoms of fever of 100.4°F (38°C) or higher, pain, and belly tenderness will usually start within 2 to 3 days of the procedure. But you can have a serious infection without fever.
• Blood clots blocking the cervix (hematometra). If the uterus doesn't contract to pass all of the tissue, the cervical opening can become blocked. This prevents blood from leaving the uterus. The uterus will become enlarged and tender. Belly pain, cramping, and nausea may be present.
• Moderate to severe bleeding (hemorrhage). Bleeding may be more than normal if:
  • Products of conception are retained in the uterus.
  • The uterus has not contracted toward its prepregnancy size (atony).
  • Uterine muscle rupture has occurred. In rare cases, a uterine incision scar tears open when a medicine is used to induce contractions.

When a medical abortion fails, a surgical abortion must be done as follow-up to prevent complications or development of a fetus with abnormalities.

Follow-up examination after a medical abortion

A follow-up examination is done in 1 to 3 weeks after a medical abortion. The examination may include:

• A physical exam, to check the cervix and uterus.
• A lab test to check for a low human chorionic gonadotropin (hCG) level, which shows the pregnancy has ended.
• A blood test, to check for anemia.
• An ultrasound, to confirm the uterus is empty.
• 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.