Guidelines 2016 – Postabortion Care: Medical and Surgical
Guidelines for Nurse Practitioners in Gynecologic Settings 2016
■ EXAMINATION AFTER MEDICAL OR SURGICAL ABORTION
I. DEFINITION
An examination usually 2 weeks after uncomplicated therapeutic abortion to assess the patient’s physical and mental status
II. ETIOLOGY
POSTABORTION CARE: MEDICAL AND SURGICAL 171
Therapeutic or elective abortion
III. HISTORY
A. What the patient may present with
1. Surgical
a. No unusual complaints
b. Rare complications may include
i. Excessive blood loss (typical length of light-to-moderate flow is 9 days)
ii. Pelvic infection
iii. Pelvic perforation
iv. Acute hematometra
2. Medical
a. Nausea
b. Vomiting
c. Headaches
d. Fever
e. Chills
f. Bleeding: Average length of bleeding is 10 to 13 days; however, heavy bleeding may occur.
B. Additional information to be considered
1. Date of abortion; type of procedure
2. Date of last menstrual period
3. Are pregnancy symptoms resolved? If not, what symptoms continue?
4. How long after procedure did bleeding continue? Any pain associated with bleeding? How much bleeding? Any clots? Characteristics of bleeding? Odor to discharge? Fever?
5. Results of pathological examination of products of conception (if available)
6. Any change in relationship with partner?
7. Present emotional status
8. Birth control method
9. Intercourse since procedure
10. Medications taken, including antibiotics, oxytocins, herbals, vita- mins, and homeopathics
IV. PHYSICAL EXAMINATION
A. Vital signs
1. Blood pressure
2. Pulse
B. Abdominal examination: suprapubic tenderness, guarding, rigidity
C. Vaginal examination (speculum)
1. Observe for bleeding or other discharge
2. Cervix
a. Os closed
b. Any lesions
c. Any discharge
D. Bimanual exam
1. Uterus
a. Size
b. Consistency
c. Tenderness
d. Cervix: positive cervical motion tenderness (CMT); open os (millimeters)
2. Adnexa
a. Tenderness
b. Masses
3. Rectovaginal: as needed for any abnormal findings on vaginal, uterine, or adnexal exam
V. TREATMENT
A. Birth control
1. Hormonal contraception: birth control pills, Depo-Provera, contra- ceptive ring, patch, implant
2. Diaphragm, FemCap
3. IUD, intrauterine contraceptive device (IUCD): hormonal and nonhormonal
4. Other methods (over the counter [OTC]): male and female con- doms, spermicides, sponge, vaginal contraceptive film
5. Sterilization (if desired)
B. General measures: review use, potential side effects, and sign informed consent form if necessary (see Appendix A)
VI. LABORATORY EXAMINATION
A. Pregnancy test as indicated
B. Wet mount as indicated
VII. DIFFERENTIAL DIAGNOSIS
A. None
VIII. COMPLICATIONS
A. See Postabortion Complications section.
B. If unresolved issues are apparent, follow-up counseling or referral to medical specialist recommended
IX. CONSULTATION/REFERRAL
A. See Postabortion Complications section.
B. If unresolved issues are apparent, follow-up counseling will be recommended.
X. FOLLOW-UP
A. Yearly for health examination, Pap smear (per the American Society for Colposcopy and Cervical Pathology [ASCCP] guidelines), reevalu- ation of family planning needs
B. As per guideline for contraceptive of woman’s choice
See Appendix I and Bibliographies.