Postabortion Care

1
Postabortion Care

• Managing Complications in Pregnancy and Childbirth

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Session Objective

• To discuss the essential elements of postabortion
  care
• Emergency treatment of abortions and potentially
  life-threatening complications following
  abortions
• Postabortion family planning (FP) counseling and
  services
• Links between postabortion emergency services and
  the reproductive healthcare system

3
Elements of Postabortion Care
Emergency
FP Counseling
Treatment
Services
Other
Reproductive
Health Services
4
Postabortion Care Emergency Treatment

• Initial screening (triage) for emergency
  conditions
• Talking to the client regarding her condition
• Medical assessment
• Stabilization (IVs, antibiotics) prior to manual
  vacuum aspiration (MVA)
• Uterine evacuation by MVA
• Referral or transfer for extensive treatment
  (e.g., major surgery)

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Rationale for Using Manual Vacuum Aspiration (MVA)

• MVA is the preferred treatment of incomplete
  abortion because
• Risk of post-evacuation complications is reduced
• Less expensive, reusable equipment is used
• Emergency postabortion care can be provided at
  remote sites (small clinics) not just in urban
  centers

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Comparison of Complication Rates

• Summary of 13 Studies

DCDilatation and Curettage
Greenslade et al 1993.
7
Average Total Patient Stay for Manual Vacuum
Aspiration vs. Dilatation Curettage
Kenya
Johnson, Benson and Hawkins 1992.
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Need for Postabortion Family Planning Services

• Unsafe abortion is a prime indicator of unmet
  need for FP
• Failure to provide FP is a major contributor to
  the problem of unsafe abortion
• Emergency treatment is not linked to FP
  counseling or services

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Importance of Starting Postabortion Family
Planning Immediately

• Increased risk of repeat pregnancy because
• Ovulation may occur by day 11 postabortion
• 75 of women will have ovulated within 6 weeks
  postabortion

Lähteenmäki 1993 Lähteenmäki et al 1980.
10
Which Family Planning Methods to Use Postabortion

• All modern methods are acceptable provided that
• Thorough counseling is given to ensure
  voluntarism and choice
• Clients are screened for precautions

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Providing Postabortion Contraception
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Linkages to Other Reproductive Health Services

• Linkages are essential and logical if the
  reproductive health of women is to improve
• Lack of linkages contributes to womens continued
  poor health status

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Examples of Other Reproductive Health Services

• Treatment of sexually transmitted infections
• Cervical cancer screening for women over age
  3035
• Infertility services
• Pre-pregnancy advice (e.g., nutrition,
  immunization, management of existing medical
  conditions)

14
References
Greenslade FC et al. 1993. Manual Vacuum
Aspiration A Summary of Clinical and
Programmatic Experience Worldwide. Ipas
Carrboro, North Carolina. Johnson BR, J Benson
and BL Hawkins. 1992. Reducing resource use and
improving quality of care with MVA. Advances in
Abortion Care 2(2) 16. Lähteenmäki P. 1993.
Postabortal contraception. Ann Med 25
185189. Lähteenmäki P et al. 1980. Coagulation
factors in women using oral contraceptives or
intrauterine contraceptive devices immediately
after abortion. Am J Obstet Gynecol 141(2)
175179.