Abortions, when done safely and as directed, are incredibly effective. Very rarely are abortions considered incomplete. However, it can still happen. Therefore, it is important to make patients aware of the potential signs of incomplete abortion and know when to refer them to an in-person visit.
Why It’s Important to Confirm Abortion Completion
Any medical procedure is going to carry some level of risk, and that includes abortion. One such risk is that of an incomplete abortion. An incomplete abortion can, of course, cause continued pregnancy, but it can also lead to infection, excessive bleeding, and other complications.
Because of these adverse effects, it is important to confirm abortion completion after a patient takes abortion pills or has a surgical abortion. Confirmation can bring peace of mind to the patient while also allowing providers to medically intervene if needed. Thus, confirmation of abortion completion is a mainstay of post-abortion care.
Signs and Symptoms of a Completed Abortion
Because of the potential risks of incomplete abortion, it is essential to be aware of common signs and symptoms that would indicate a complete abortion. If a patient presents with the following, it is likely that the abortion is complete:
- Bleeding and cramping. The frequency and severity of these should decrease over the course of several days.
- Pregnancy tissue. A patient will likely notice passage of pregnancy tissue during a medical abortion.
- Lack of pregnancy symptoms. If the individual has symptoms such as nausea or breast tenderness while pregnant, these should stop after an abortion.
- Negative pregnancy test. After an abortion, someone should typically have a negative pregnancy test within 4-6 weeks of an abortion. However, hCG, a pregnancy hormone detected in pregnancy tests, may linger for longer.
Clinical Methods to Verify Completion
Although the above signs and symptoms can be a good indicator that an abortion was successful, it’s always a good idea that providers confirm this with an in-office visit. Providers can use a few methods to confirm abortion completion. These include:
- Ultrasound
- Blood test
- Pelvic exam
- Urine pregnancy test
When to Suspect an Incomplete Abortion
While it’s important to know the signs of a complete abortion, it’s also good to be aware of symptoms associated with an incomplete abortion. If a patient presents with the following, they’ll likely require additional follow-up:
- Signs of infection, such as a fever
- Continuous heavy vaginal bleeding that doesn’t resolve
- Serious abdominal pain and cramping
- Hypotension
If a patient experiences any of these symptoms, the abortion may not be complete. In such cases, they should seek medical attention to confirm the outcome of the abortion. As a provider, you can do a full assessment of whether or not the abortion is complete.
Follow-Up Care: Next Steps After Confirmation
After the abortion is confirmed, there are a few more things to keep in mind. First, providers should discuss contraceptive options with their patients. Reproductive planning will give patients peace of mind that they are protected from pregnancy if that is something they are looking to avoid in the future. There are many different birth control methods available, so be sure to have a discussion with your patient as to which might be the best option for them.
It isn’t uncommon to have strong emotions or feelings before, during, and after an abortion. If you think your patient could benefit from professional support, consider suggesting they seek therapy and counseling. Advise them to take care of themselves in the days and weeks following the abortion, taking adequate time to rest and recharge.
Even when an abortion is confirmed complete, it’s always good to be aware of signs of any other complications. In particular, counsel patients to look out for symptoms of infection, such as fever. If they experience anything concerning, they should seek out medical attention.
When to Refer for In-Person Evaluation
An in-person evaluation will be required if you suspect an incomplete abortion. Thus, advise your patients to schedule an in-person visit if they experience any of the following:
- A positive pregnancy test after several weeks
- Symptoms indicating an incomplete abortion
- Symptoms indicating an infection
- Serious or worsening pain, bleeding, or fever
An in-person visit will allow for a thorough assessment and timely intervention in the case of incomplete abortion or other complications.
Conclusion
In summary, although abortions are incredibly safe and effective, there can still be complications in rare instances. One such complication is incomplete abortion, where a pregnancy continues despite undergoing a medical abortion.
To mitigate the risks associated with an incomplete abortion, it is important to advise patients on the signs and symptoms of both a complete and incomplete abortion. If you suspect an incomplete abortion, direct your patients to an in-person office visit immediately.
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