20.3.3  Follow-up care after an abortion

Prevention of abortion-related illness and mortality is dependent on the availability of comprehensive post-abortion care throughout the healthcare system. Whether it is health information and education, stabilisation of symptoms and timely referral, safe methods of abortion, or specialised care for the most severe complications, at least some components of post-abortion care should be available at every service delivery site in the healthcare system, including at Health Posts. If the woman had a miscarriage or a safely induced abortion at a health facility, she is less likely to develop a serious infection or injury than a woman whose abortion was done illegally by someone who used unsafe tools.

Emergency post-abortion care refers to the actions you should take if any of the complications in Box 20.2 arise after an abortion.

Box 20.2  Complications after an unsafe abortion

The most serious complication is death. It is estimated that around one-third of maternal deaths in Ethiopia are due to unsafe abortions. For every woman who dies, it is estimated that another 16 to 33 women suffer a complication after an unsafe abortion, including:

  • Haemorrhage (heavy bleeding)
  • Infection in the pelvic cavity, or in the bloodstream (e.g. tetanus)
  • Perforation of the uterus (puncturing the wall of the uterus by a sharp instrument)
  • Injury to adjacent organs in the pelvic cavity (e.g. vagina, urinary bladder, rectum, intestines)
  • Poisoning from an overdose of medicines or herbs used to induce abortion.

In the longer term, a woman can suffer from chronic (persistent) pelvic pain, especially during menstruation, repeated spontaneous abortion or infertility.

Important! If a woman has any of these warning signs after an abortion, refer her to the nearest health centre or hospital

You should check the woman’s health, pulse, temperature and blood pressure regularly after an abortion and question her carefully and sensitively to reveal any of the following warning signs and symptoms:

  • Strong cramping pains in the lower abdomen
  • Swollen or hard lower abdomen with no sounds or gurgles inside
  • Heavy bleeding, large clots of blood or bleeding for more than 2 weeks
  • Bad smell coming from the vagina
  • Fever: temperature 38°C or above
  • Fast pulse: more than 100 beats per minute
  • Feeling very nauseated, faint or dizzy
  • Low or falling blood pressure, below the bottom of the normal range of 120/70 mmHg.

If heavy bleeding occurs, you may not be able to see the blood if it is leaking into the woman’s abdomen from an injury to her uterus or other internal organs, which may occur after an unsafe abortion. Heavy loss of blood leads to a condition known as shock (Box 20.3).

Box 20.3  Signs of shock

A woman in shock will be pale and sweating, with a fast pulse (above 100 beats per minute), fast respiration, low or falling blood pressure (the diastolic pressure — the bottom number — is below 60 mmHg), and dizziness or confusion; she may even lose consciousness. You must act quickly to save her life.

20.3.2  Important messages for women after a spontaneous or induced abortion

20.3.4  Pre-referral treatment in an emergency