Surgical Abortion Care

Topic Overview

Care before a surgical abortion

Before a surgical abortion, your doctor will:

• Evaluate your past health, 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 the location and health 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 the procedure, possible problems, and when to call your doctor.

Care immediately after a surgical abortion

After a surgical abortion procedure, your doctor will check to make sure:

• Your vital signs such as heart rate, breathing, and blood pressure are normal.
• Bleeding is not excessive.
• Uterine contractions are normal.
• Side effects from anesthetic (local or general) are not causing problems.

Medicines that may be given after a surgical abortion include:

• Antibiotics, to prevent infection.
• Medicines that cause uterine contractions (uterotonic), to empty the uterus completely and reduce bleeding.
• Rh immunoglobulin, which is given to all women who have Rh-negative blood type to prevent Rh sensitization after the procedure.
• Pain medicine, for cramping pain caused by uterine contractions.
• Medicine to treat nausea or vomiting.

Care at home after a surgical abortion

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

• Most women can return to normal activities in 1 to 2 days after the procedure. Avoid strenuous exercise for about 1 week.
• Do not have sexual intercourse for at least 1 week, or longer, as advised by your doctor.
• When you start having intercourse again, use birth control, 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 surgical abortion include:

• Irregular bleeding or spotting for the first 2 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.

Signs of complications

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 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:

• 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.

Follow-up exam after a surgical abortion

A follow-up exam may be done about 2 weeks after a surgical abortion. The exam 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 means that the pregnancy has ended.
• A blood test, to check for anemia.
• 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. If you had an intrauterine device (IUD) inserted at the time of the abortion procedure, you can discuss with your doctor any questions you have.