Abortion means termination of pregnancy. This could be done for medically indicated reasons such as an abnormality in the fetus detected on ultrasound or severe health conditions in the mother. Or, it can be done on request by the woman or couple due to various reasons including failure of contraception or social reasons.
It is a common procedure done by gynaecologists in healthcare facilities and is mostly quite safe. However, if done under unsafe conditions it can be life-threatening to the woman. An estimated 25 million unsafe abortions occur, every year, making it one of the leading causes of maternal mortality and morbidity worldwide. In India, 67% of abortions in the study population in India were classified as unsafe, varying widely across the states. It was found to be higher among the vulnerable and disadvantaged populations in India. Also, young women aged 15-19 years were at the highest risk of dying from an abortion-related complication. Hence, there is an urgent need to understand the barriers to women seeking abortion care in all tiers of urban and rural India and act upon improving abortion care.
A termination may have been performed in the first trimester (4-13 weeks) or the second trimester (13 weeks to 24 weeks). The more advanced the stage of pregnancy, the higher the complications. Termination of pregnancy can be done either medically or surgically depending on medical factors and the woman’s choice. The three important complications are excessive bleeding, retained products of pregnancy, and injury to the womb or the neck of the womb. Pregnancy located outside of the womb, also called ectopic pregnancy must be ruled out before performing an abortion.
It is usually done as a day-care procedure. After the procedure, the woman is observed for any complications such as bleeding, pain or signs of infection. The woman is discharged home the same day once she is comfortable. A course of painkillers and antibiotics are given at the time of discharge. The antibiotic course must be completed without fail to avoid infection. If the woman has a negative blood group, there may be a requirement for an Anti-D injection.
CARE AT HOME
The woman needs to rest after the procedure. The number of days of rest depends on the stage of pregnancy. Also, a prolonged period of rest may be required in certain situations such as excessive blood loss. Normal activities may be resumed the next day in most cases of first-trimester abortion.
Pain is expected after a medical or surgical procedure for a few weeks. It is usually crampy and is relieved by oral painkillers.
Bleeding is also expected for up to four weeks after the procedure but in most cases, bleeding is on and off for up to a week or so. Ideally, sanitary pads are recommended rather than tampons or menstrual cups during this time. Pregnancy symptoms usually subside by about 2-3 days.
RED FLAG SIGNS AND SYMPTOMS
Women must be aware of red flag signs to report immediately Any signs of infection such as temperature above 100 degrees F, pain in the tummy, and unusual or unpleasant odour are to be watched out for. Heavy bleeding with clots or feeling dizzy and faint must also be immediately reported. It is likely to have mood disturbances following the procedure which must be addressed if troublesome or severe.
WHAT ABOUT THE NEXT PREGNANCY?
Both medical and surgical terminations, if performed safely, do not cause any trouble getting pregnant again. However, infection or retained products or injury to the womb may affect the ability to conceive again. Hence, the importance of a safe procedure under supervision.
It is important to discuss contraception during the follow-up after the procedure to avoid an unintended pregnancy. If performed surgically, a long-acting reversible intrauterine device can be placed at the same time. If not, this discussion can happen after normal period resumes about 4-6 weeks following the procedure.
A safely performed termination under the supervision of a trained healthcare professional with proper post-abortion care can help a woman recover faster and completely without any long-term risks to her future health and pregnancy.