Hesperian Health Guides
Complications of Abortion
Early treatment of abortion complications prevents illness, infertility, and death. Seek help quickly if you have problems after an abortion. DO NOT WAIT!
- 1 Heavy bleeding from the vagina
- 2 Emergency Help for Too Much Bleeding
- 3 Shock
- 4 Infection
- 5 Injury inside the body (internal injury)
- 6 Emotional support after a pregnancy ends
Heavy bleeding from the vagina
Heavy bleeding is the most common problem after an abortion. It is usually caused by pieces of the pregnancy that are left in the womb. The womb cannot squeeze itself shut and keeps bleeding. This is called an incomplete abortion. If the pieces are removed, often the bleeding will stop. Sometimes the bleeding is caused by a torn cervix which must be stitched for the bleeding to stop.
A woman is bleeding too much if she soaks more than 2 heavy pads or cloths in one hour for 2 hours in a row. A slow, steady trickle of bright red blood is also dangerous. When this happens, a woman may quickly lose a dangerous amount of blood. If it is not possible to get medical help immediately, try to stop the bleeding.
To stop the bleeding
A woman who is bleeding too much may be able to help her womb squeeze shut with massage. She can do this herself or have someone else do it. Rub or massage the lower belly very hard while lying down or squatting.
If there are pieces of tissue stuck in the womb or cervix, she may be able to push them out herself by squatting and bearing down as if passing stool or giving birth.
Even if these treatments seem to work, get medical help as soon as possible. The woman will need antibiotics and may still need to have her womb emptied completely.
Emergency Help for Too Much Bleeding
Health workers and others trained in giving a woman a pelvic exam may be able to follow these steps to try and stop the bleeding until the womb can be emptied.
- Wash your hands and the woman‘s genitals with soap and clean water.
- Put a clean latex or plastic glove or a very clean plastic bag on one hand. The gloved hand should not touch anything before it goes into the woman’s vagina.
- Have the woman lie on her back with her feet and knees apart. Help her relax.
- If you have a sterile speculum (you can get the right instruments from an IUD kit if you have one), put it into the vagina so you can see the opening of the womb. If you can see tissue or clots or lumps of blood there, try to get hold of them with sterile forceps or clamps and gently remove them.
- If you do not have a speculum, reach inside the woman’s vagina with your gloved hand, first with 1 finger, and then with 2 fingers.
- Feel for the cervix. It will feel more firm and smooth than the skin around it. It looks like this.
- Move your finger across the opening and feel for bits of the pregnancy that may be sticking out of the opening. They will feel like soft meat. Gently try to remove them. If the pieces are too slippery, take your hand out and wrap 2 fingers with sterile gauze, or a clean cloth that has been boiled in water, and try again to remove them.
- After you have removed the pieces, put your gloved hand into the woman’s vagina with two fingers under the womb. With your other hand, rub or massage her belly to help stop the bleeding. Her womb should be between your 2 hands.
- Give the woman an injection of ergometrine (0.2 mg) in a large muscle, such as her buttock or thigh. Then give her one 0.2 mg pill or injection of ergometrine every 6 hours for 24 hours. Or you can use misoprostol: give 600 mcg by mouth or insert 600 mcg into the rectum (wear gloves).
- Give antibiotics to prevent infection immediately. She is at high risk of infection because the womb is open to germs.
- If she is awake, give her fluids to drink. If she is unconscious, see the next page.
- Take her to a hospital right away, even if you think you have removed the tissue and the bleeding has stopped. She still needs to have her womb emptied completely. If the bleeding does not stop, continue to rub or massage her lower belly while taking her to the hospital.
|Use sterile forceps to remove any tissue you see at the opening of the womb.|
the cervix, opening of the womb
More Informationhow to give an injection
Shock is a life-threatening condition that can result from heavy bleeding. Bleeding inside the body can also cause shock.
DANGER! Heavy bleeding can cause SHOCK, which can kill. Transport immediately.
- very fast heart rate, more than 100 beats a minute for an adult
- pale, cold, damp skin
- pale inner eyelids, mouth, and palms
- fast breathing, more than 30 breaths a minute
- confusion or unconsciousness (fainting)
Treatment if she is conscious:
- Lay the woman down with her feet higher than her head.
- Cover her with a blanket or clothes.
- If she can drink, give her sips of water or rehydration drink.
- Help her to stay calm.
- If you know how, start a fast intravenous drip (IV) with a wide needle, or start rectal fluids.
Treatment if she is unconscious:
- Lay her on her side with her head low, tilted back and to one side, and her feet high.
higher than her head.
- If she seems to be choking, pull her tongue forward with your finger.
- If she has vomited, clean out her mouth immediately. Be sure her head is low, tilted back and to one side, so she does not breathe vomit into her lungs.
- Do not give her anything by mouth until she has been awake for one hour.
- If you know how, start a fast IV drip with a wide needle. If you do not, start rectal fluids.
Do not wait for a health worker. Take the woman for medical help or to a hospital right away. She needs medical help fast!
If there is infection, it is more likely to be a mild infection if the abortion was done sooner than 3 months (12 weeks) after the last monthly bleeding.
Serious infection is an infection that has spread into the blood (sepsis). A woman is more likely to have a serious infection if the abortion was done later than 3 or 4 months from the last monthly bleeding, or if there was an injury to the womb during the abortion. Sepsis is very dangerous and can also cause shock. Infection can happen because:
- an unclean hand or object was put inside the womb.
- pieces of the pregnancy were left inside the womb and they have become infected.
- the woman already had an infection when she had the abortion.
- a hole was made in the wall of the womb.
Signs of mild infection:
- slight fever
- mild pain in the abdomen
Treatment for mild infection:
To keep mild infection from becoming serious, treat it immediately with the medicines listed below. A woman needs more than one medicine because infections after abortion are caused by several different kinds of germs.
Signs of serious infection:
Treatment for serious infection:
- Take the woman to a health center or hospital immediately.
- Start the following medicines right away, even if you are already on your way to the hospital.
Medicines for infection after abortion
|Give one of these combinations of medicines (give all 3 medicines):|
|Give all 3 medicines|
|ceftriaxone||1 to 2 g IV or IM||every 12 to 24 hours for 4 to 7 days|
|doxycycline||100 mg by mouth||2 times a day|
|(avoid taking doxycycline if you are breastfeeding)|
|metronidazole||500 mg by mouth or by IV||4 times a day|
|ampicillin||2 g (2000 mg) IV or IM the first time only, then 1 g (1000 mg) IV or IM each other time||6 times a day|
|gentamicin||80 mg IV or IM||3 times a day|
|metronidazole||500 mg by mouth or IV||4 times a day|
|Give 2 medicines|
|clindamycin||900 mg IV||3 times a day|
|gentamicin||80 mg IV or IM||3 times a day|
IMPORTANT! If the woman is not improving within 24 hours of starting the first medicines, she needs to go to the hospital right away.
|Stop giving medicines by injection or IV when the signs of infection have been gone for 48 hours. Then start giving medicines by mouth with plenty of water.|
|When signs have been gone for 48 hours|
|Give 2 medicines:|
|doxycycline||100 mg by mouth||2 times a day for 10 days|
|(avoid taking doxycycline if you are breastfeeding)|
|metronidazole||500 mg by mouth||4 times a day for 10 days|
Injury inside the body (internal injury)
An internal injury from an abortion is most often caused by a sharp object that makes a hole in the womb. The object may also cause damage to other internal organs, such as the tubes, ovaries, intestines, and bladder.
When a woman has internal injuries she may have severe bleeding inside her abdomen but almost no bleeding from her vagina.
Signs (she will have some or all of these):
|Listen for gurgles for 2 minutes.|
- her abdomen feels stiff and hard with no sounds or gurgles inside
- very bad pain or cramps in the abdomen
- nausea and vomiting
- pain in one or both shoulders
- Immediately take the woman to a hospital or clinic where she can have surgery. An injury inside the body must be repaired right away by a surgeon or it can lead to infection, shock, and death.
- Do not give her anything by mouth — no food, no drink, not even water — unless it will take more than 12 hours to get to a health center. Then give water only in small sips. Or let her suck on a piece of cloth soaked in water.
- If she has signs of shock, treat her for shock. Make sure nothing is blocking her mouth and that she can breathe.
- Give her the medicines for infection. If possible, give her a tetanus toxoid vaccination.
Emotional support after a pregnancy ends
A woman may have strong feelings after an abortion, even if she knows she made the right decision for herself and her family. Some women feel a mixture of relief, sadness, grief, guilt, shame, anger, and even love. It is also common for women to feel sad and grieve when a pregnancy ends. These feelings are normal, but having to hide them and pretend nothing happened can make them worse. Many women find it helpful to talk with other women who have had the same experience.
Usually, a woman who is having serious health problems because of an abortion did not get good care. An abortion provider who did not do a safe abortion may also have been disrespectful or unkind. The abortion may have been very painful or frightening for the woman. When abortion is illegal, a woman may be afraid of being punished.
Creating a ritual to reflect on what happened can also help women let go of the experience and move on with life. For example, burying or burning an object related to the abortion can symbolize closure. In some communities, a woman may plant a tree or visit a sacred place and make offerings.