Clinical care for voluntary abortion and post-abortion care

Pharmacological and Surgical Methods

The clinical management of pregnancy termination in adolescent patients requires the rigorous application of protocols based on the best available scientific evidence, prioritizing safe, outpatient, and minimally invasive procedures.

The first-line pharmacological approach consists of a combined regimen of oral mifepristone—a progesterone receptor antagonist that halts pregnancy progression and softens the cervix—followed by misoprostol administered sublingually, orally, or vaginally to induce myometrial contractions and uterine evacuation.

This regimen demonstrates efficacy rates exceeding ninety-five percent in the first trimester and must be strictly adjusted according to the number of weeks of amenorrhea and the young woman’s body weight.

In circumstances where drug treatment is contraindicated, fails, or the patient opts for an immediate, single-step solution, manual vacuum aspiration (MVA) is the surgical gold standard, having completely replaced cutting curettage due to the lower risk of uterine perforation, endometrial adhesions, and hemorrhage.

At the same time, pain management and hemodynamic stability are non-negotiable components of treatment.

Colic pain must be prevented and alleviated through stepwise prophylactic analgesic regimens, using nonsteroidal anti-inflammatory drugs such as ibuprofen, multimodal analgesia, and paracervical block in cases requiring instrumentation.

Technical care must be integrated with continuous empathetic communication that alleviates anxiety, confirms the blood type in advance for the administration of anti-D immunoglobulin if the patient is Rh-negative, and preserves the minor’s autonomy at every stage of the procedure.

Post-abortion care and immediate contraception

Follow-up care after uterine evacuation is critical to prevent infectious complications and ensure the adolescent’s physical and emotional recovery.

The medical team must proactively monitor for the onset of early or late complications, such as excessive genital bleeding (clinically defined as soaking more than two sanitary pads per hour for two consecutive hours), retained fetal tissue, and post-procedure endometritis.

It is imperative to educate the patient and her support network about warning signs at home that require immediate hospital care: a fever higher than 38 °C, severe pelvic pain that does not subside with conventional analgesics, and foul-smelling vaginal discharge.

At the same time, the period immediately following the procedure opens a crucial window for preventive intervention known as Immediate Post-Obstetric Event Contraception (AIPEO).

Since ovulation can resume early—even within the first ten to fourteen days following the termination—reproductive counseling should never be delayed.

Priority should be given to offering and inserting long-acting reversible contraceptives (LARCs), such as the progestin-only subdermal implant or the intrauterine device (the latter contingent on the absence of suspected active infection), before medical discharge, ensuring highly effective protection that does not depend on daily adherence.

This care package should be supplemented with sexual health counseling, the provision of barrier condoms for infection prevention, and referral to stigma-free psychological support networks.

Summary

The clinical management of pregnancy termination in adolescents prioritizes combined regimens of mifepristone and misoprostol or manual vacuum aspiration as sa r highly effective methods. Ensuring adequate analgesia and monitoring hemodynamic stability are essential requirements for making the procedure a respectful and trauma-free care experience.

Post-procedure clinical monitoring requires the early identification of retained tissue, abnormal bleeding, and pelvic infections. Clearly instructing patients on warning signs to watch for at home enables them to seek timely emergency care in the event of fever, disproportionate pain, or abnormal lochia.

The immediate implementation of post-procedure contraception effectively prevents subsequent unplanned pregnancies given the rapid resumption of ovulatory activity. Establishing long-acting reversible methods before hospital discharge ensures continuous protection and consolidates a comprehensive and protective therapeutic outcome.