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Pre-abortion management

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Initial assessment

  • The first step in pre abortion management is to confirm the pregnancy by establishing a history of amenorrhoea and early pregnancy symptoms such as nausea, breast tenderness, fatigue and a reliable urine pregnancy test.
  • Pre-abortion assessment includes:
    • rhesus blood status
    • where clinically indicated
      • determination of blood group with screening for red cell antibodies
      • measurement of haemoglobin concentration
      • testing for haemoglobinopathies
    • venous thromboembolism (VTE) risk assessment
  • Women who have not had cervical cytology screening within the recommended interval should be offered screening within the abortion service, or advised on when and where to obtain it.
  • Use of routine pre-abortion ultrasound scanning is unnecessary but must be available to all services as it may be required as part of the assessment.

Prevention of infective complications

  • Services should offer antibiotic prophylaxis effective against C. trachomatis and anaerobes for both surgical abortion and medical abortion. The following regimens are suitable for peri-abortion antibiotic prophylaxis:
    • azithromycin 1 g orally on the day of abortion plus metronidazole 1 g rectally or 800 mg orally prior to or at the time of abortion OR
    • doxycycline 100 mg orally twice daily for 7 days starting on the day of abortion, plus metronidazole 1 g rectally or 800 mg orally prior to or at the time of abortion OR
    • metronidazole 1 g rectally or 800 mg orally prior to or at the time of abortion for women who have tested negative for C. trachomatis infection
  • All women should be screened for C. trachomatis and undergo a risk assessment for other STIs (such as HIV, gonorrhoea, syphilis).

Contraception

  • All appropriate methods of contraception should be discussed with women at the initial assessment and a plan for contraception after the abortion (1).

Feticide

  • Feticide (destruction of fetus in the uterus) should be performed after 21 weeks and 6 days of gestation to ensure no risk of live birth.

Reference:

  1. Royal college of obstetricians and gynaecologists (RCOG) 2011. The care of women requesting induced abortion. Evidence based clinical guideline number 7.

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