Pre-abortion management

Initial assessment

• The first step in pre abortion management is to confirm the pregnancy by establishing a history of amenorrhoea and early pregnancy symptoms such as nausea, breast tenderness, fatigue and a reliable urine pregnancy test.
  
• Pre-abortion assessment includes:
  • rhesus blood status
  • where clinically indicated
    • determination of blood group with screening for red cell antibodies
    • measurement of haemoglobin concentration
    • testing for haemoglobinopathies
  • venous thromboembolism (VTE) risk assessment
• Women who have not had cervical cytology screening within the recommended interval should be offered screening within the abortion service, or advised on when and where to obtain it.
• Use of routine pre-abortion ultrasound scanning is unnecessary but must be available to all services as it may be required as part of the assessment.

Prevention of infective complications

• Services should offer antibiotic prophylaxis effective against C. trachomatis and anaerobes for both surgical abortion and medical abortion. The following regimens are suitable for peri-abortion antibiotic prophylaxis:
  • azithromycin 1 g orally on the day of abortion plus metronidazole 1 g rectally or 800 mg orally prior to or at the time of abortion OR
  • doxycycline 100 mg orally twice daily for 7 days starting on the day of abortion, plus metronidazole 1 g rectally or 800 mg orally prior to or at the time of abortion OR
  • metronidazole 1 g rectally or 800 mg orally prior to or at the time of abortion for women who have tested negative for C. trachomatis infection
• All women should be screened for C. trachomatis and undergo a risk assessment for other STIs (such as HIV, gonorrhoea, syphilis).

Contraception

• All appropriate methods of contraception should be discussed with women at the initial assessment and a plan for contraception after the abortion (1).

Feticide

• Feticide (destruction of fetus in the uterus) should be performed after 21 weeks and 6 days of gestation to ensure no risk of live birth.

Reference:

1. Royal college of obstetricians and gynaecologists (RCOG) 2011. The care of women requesting induced abortion. Evidence based clinical guideline number 7.