Synopsis
Differentiate expected recovery from haemorrhage, infection, ongoing pregnancy, ectopic pregnancy and procedural injury, then provide proportionate physical and emotional aftercare.
- Expected recovery depends on method and gestation: cramping and bleeding are usually heavier during medical expulsion, while surgical abortion often gives shorter, lighter bleeding and procedure-related discomfort.
- Transient nausea, diarrhoea, chills and feverishness can follow misoprostol, but persistent fever, worsening pain or systemic illness should not be attributed to the medicine.
- Major post-abortion differentials are haemorrhage, retained products, ongoing pregnancy, infection, ectopic pregnancy, cervical trauma and uterine perforation with possible visceral injury.
- Resuscitation and cause-specific control occur together: prepare blood, consider ultrasound, examine when safe and use uterotonics, aspiration, tamponade, embolisation or surgery according to the senior assessment.
- Suspected sepsis requires prompt cultures where they do not delay therapy, broad-spectrum intravenous antibiotics and evacuation of infected retained tissue when indicated.
- After early home medical abortion, use the supplied low-sensitivity or multi-level urine test; continuing symptoms, little bleeding or a positive result needs service review.
- Provide written expected symptoms, a 24-hour contact and exact emergency thresholds before discharge, checking privacy, language, transport and ability to return.
- A range of emotions is common; offer support or counselling when requested and reassure that abortion itself is not associated with increased infertility, breast cancer or mental-health problems.
Key red flags
Bleeding that is rapidly soaking protection, passing very large clots, causing dizziness, syncope, breathlessness or weakness requires urgent assessment rather than remote reassurance.
Fever, rigors, offensive discharge, worsening pelvic pain, tachycardia or systemic illness can indicate endometritis, retained infected tissue or sepsis.
Persistent pregnancy symptoms, very little bleeding after medical treatment or a positive scheduled follow-up test raises concern for ongoing pregnancy or failed treatment.
New unilateral pain, shoulder-tip pain, rectal pressure, collapse or peritonism after an abortion before location was proven may be an ectopic pregnancy.
Severe or increasing abdominal pain, guarding, shoulder pain, distension or haemodynamic change after instrumentation can indicate uterine perforation, visceral injury or internal bleeding.
Investigation priorities
Assess anaemia, infection response, platelet count and coagulopathy during significant bleeding or systemic illness.
Management branches
Treatment is complete and the patient is clinically suitable to leave the service.
- Explain method-specific pain, bleeding, gastrointestinal effects and the likely recovery trajectory in an accessible written and verbal format.
- Provide a functioning 24-hour number and urgent instructions for collapse, very heavy loss, increasing pain, fever, offensive discharge or persistent pregnancy symptoms.
- Supply any completion test, analgesia plan and chosen contraception, confirm safe contact preferences and offer emotional or bereavement support without compulsion.