Guidelines 2016 – Postabortion Complications
Guidelines for Nurse Practitioners in Gynecologic Settings 2016
I. DEFINITION
Any sequelae or unexpected/untoward events or conditions following a therapeutic/elective abortion, either medical or surgical
II. ETIOLOGY
Therapeutic/elective abortion: medical or surgical
III. HISTORY
A. What the patient may present with
1. Fever, body aches, chills
2. Pelvic pain, severe cramps
3. Bleeding; more than one pad per hour
4. Passing clots larger than a quarter
5. Abdominal pain: right or left side or bilateral; onset, duration, attempts at relief, and outcomes
6. Nausea, vomiting, diarrhea
7. Breast tenderness, discharge
8. Foul odor to vaginal discharge
9. Vertigo, headache
B. Additional information to be considered
1. Where and when was the procedure done? Has the woman spoken to that facility regarding her symptoms or follow-up care? Type of procedure (medical or surgical)?
2. How much physical activity since procedure, type of activity
3. Any intercourse since procedure
4. Anything used in vagina since procedure: contraceptive device, tampons, sex toy, douching products
5. Urinary tract symptoms
6. Bowel symptoms
7. Any exposure to flu or anyone with similar symptoms
8. Any medications taken, such as analgesics; ergotrate; antibiot- ics; OTC or prescription drugs, including herbals, vitamins, homeopathics
9. Still feels pregnant; symptoms of pregnancy
IV. PHYSICAL EXAMINATION
A. Vital signs
1. Temperature
2. Pulse
3. Blood pressure
4. Respirations
B. Breast examination: tender (more or less tender or same since procedure); discharge from nipples
C. Abdomen
1. Bowel signs
2. Guarding
3. Rebound tenderness
4. Referred pain (shoulder pain)
D. Vaginal examination (sterile if within 1 week after procedure):
1. Os dilated or tissue in os
2. Any tissue in vagina
3. Amount of bleeding; character
4. Any discharge present; odor
E. Bimanual examination
1. CMT: positive chandelier sign
2. Uterine tenderness, enlargement; note consistency
3. Adnexa
a. Tenderness
b. Mass
c. Fullness
4. Rectovaginal examination; if necessary, look for presence of tenderness
V. LABORATORY EXAMINATION
A. Serum pregnancy test: quantitative
B. Chlamydia and gonorrhea screening
C. Cervical culture
D. Complete blood cell count with differential and sedimentation rate
E. Urinalysis and urine culture
F. Call laboratory of referring facility to obtain results of pathology report if available
VI. DIFFERENTIAL DIAGNOSIS
A. Retained secundae, continuation of pregnancy
B. Uterine infection, endometritis
C. Delayed involution
D. Pelvic inflammatory disease
E. Urinary tract infection
F. Uterine perforation, bowel perforation
G. Ectopic pregnancy
See Acute Pelvic Pain and Abdominal Pain guidelines in Chapter 17.
VII. TREATMENT
As indicated by symptoms and diagnosis; may include appropriate antibiotics, treatment of any urinary infection, ergotrate product to promote
involution; reevacuation or evacuation if failure of medical abortion; referral for evaluation of possible ectopic pregnancy (see Pelvic Inflammatory Disease, Chapter 17, and the Urinary Tract Infection section in Genitourinary Tract Conditions, Chapter 12).
VIII. COMPLICATIONS
A. Sepsis
B. Ruptured ectopic pregnancy
C. Hemorrhage
D. Uterine perforation, bowel perforation
E. Ascherman’s syndrome
IX. CONSULTATION/REFERRAL
Call the facility or clinician who performed the abortion for a consult and arrangement for return visit and further evaluation or refer to appropriate health provider/specialist.
X. FOLLOW-UP
Follow routine postabortion guideline
See Appendix I and Bibliographies.