Aftercare of obstetric emergencies

Abortion

• Reassure the woman that the chances for a subsequent successful pregnancy are good unless there has been sepsis or a cause of the abortion is identified that may have an adverse effect on future pregnancies (this is rare).
• The woman should be encouraged to delay the next pregnancy until she is completely recovered.
• If pregnancy is not desired, certain methods of family planning can be started immediately (within 7 days) provided there are no severe complications requiring further treatment
• Also identify any other reproductive health services that a woman may need:
  • Tetanus prophylaxis or tetanus booster
  • Treatment for sexually transmitted diseases (STDs)
  • Cervical cancer screening

Ectopic pregnancy

• Prior to discharge, provide counselling, a family planning method, if desired and advice on prognosis for fertility.
• Correct anaemia with oral iron.
• Schedule a follow-up visit at 4 weeks.

Molar pregnancy

• Recommend a hormonal family planning method for at least 1 year to prevent pregnancy. Voluntary tubal ligation may be offered if the woman has completed her family.
• Follow up every 8 weeks for at least 1 year with urine pregnancy test because of the risk of persistent trophoblastic disease or choriocarcinoma.
  • If the urine test becomes positive, refer the woman to a tertiary care centre for further follow-up and management.

References 1 Managing Complications in Pregnancy and Childbirth: A guide for midwives and doctors, 2007
2 WHO recommendations for Prevention and treatment of pre-eclampsia and eclampsia, 2011
3 Managing Eclampsia, 2008
4 Duley L, Henderson-Smart DJ, Walker GJ, Chou D. Magnesium sulphate versus diazepam for eclampsia. Cochrane Database of Systematic Reviews, 2010, (12):CD000127.