care after abortion
Last edited 02/2022 and last reviewed 02/2022
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.
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