Care after abortion

Rhesus prophylaxis

All non-sensitised RhD negative women should receive anti-D IgG within 72 hours following abortion, whether by surgical or medical methods:

• should be injected into the deltoid muscle
• recommended dose is 250 iu before 20 weeks and 500 iu thereafter
• a 500 iu dose gives protection for fetomaternal haemorrhage of up to 4 mL
• for abortions after 20 weeks of gestation, the size of fetomaternal haemorrhage should be assessed using either the traditional Kleihauer acid elution test or the more accurate flow cytometry
  • if test indicates a fetomaternal haemorrhage of greater than 4 mL, an additional 125 iu/mL of anti-D IgG should be administered

Information and follow-up

• Following abortion, women must be provided with information (verbal and written) about symptoms which would necessitate an urgent medical consultation or symptoms suggestive of continuing pregnancy.
• Women in whom successful abortion has not been confirmed at the time of the procedure should be offered follow-up to exclude continuing pregnancy.
• Referral should be available for any woman who may require additional emotional support or whose mental health is perceived to be at risk.

Contraception

• Before discharge, contraception methods should be discussed and initiated immediately, and contraceptive supplies should be offered.
• Intrauterine contraceptives can be inserted immediately following medical and surgical abortion at all gestations as long as it is reasonably certain that the woman is not still pregnant.
• Women who choose not to start a contraceptive method immediately should be informed about local contraceptive providers in addition to their GP.

Reference:

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