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RHO archives : Topics : Contraceptive Methods

Table 1. Contraceptive Method Use After Abortion: Presented in Order of Effectiveness

Woman's Clinical Situation

Contraceptive Method Issues

No complications

Do not delay starting method use. Most methods can be given immediately. Following uncomplicated abortion, there are no medical restrictions for:

Wait until a normal menstrual pattern returns before using natural family planning (rhythm, periodic abstinence).

Infection  (confirmed or presumptive diagnosis)

  • signs of unsafe or unclean induced abortion, or
  • signs or symptoms of sepsis or infection, or
  • unable to rule out infection

Delay female sterilization or IUD insertion until infection is either ruled out or fully resolved. Provide a short-term method and make a follow-up appointment or referral.

Consider any other method.

Trauma to genital tract

  • uterine perforation
  • serious vaginal or cervical trauma
  • chemical burns

Delay female sterilization until trauma is healed. If abdominal surgery must be done to repair trauma and if no additional risk is involved, sterilization may be done concurrently.

Delay IUD insertion until uterine perforation or other serious trauma has healed. Provide a short-term method and make a follow up appointment or referral.

Injuries that affect the vagina or cervix may limit the use of female barriers and spermicides.

Consider any other method.

Hemorrhage and severe anemia

  • Hemorrhage must be resolved before family planning can be considered.

Delay female sterilization because of the risk of further blood loss. Provide a short- term method and make a follow up appointment or referral.

The increased blood loss that can occur with use of copper IUDs may be a factor for women who are severely anemic.

Consider any other method.

Second-trimester abortion

  • If there is an excessive clotting disorder, as may be seen with missed abortion, special treatment may be needed before surgery.

Delay fitting or use of diaphragms or cervical caps for 6 weeks.

It may be more difficult to locate the fallopian tubes if female sterilization procedures are done before the uterus returns to pre-pregnancy position.

There may be a higher expulsion rate for IUDs inserted immediately after second trimester abortion.

Consider any other method.

Adapted from Winkler and Leonard. Family planning following postabortion treatment (wallchart).  Advances in Abortion Care 6(2).

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