HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Grossman, D. Articles by Walker, D. Search for Related Content PubMed PubMed Citation Articles by Grossman, D. Articles by Walker, D. Related Collections Abortion

Routine Follow-up Visits After First-Trimester Induced Abortion

Daniel Grossman, MD^*, Charlotte Ellertson, PhD, David A. Grimes, MD and Dilys Walker, MD

*Population Council, Mexico City, Mexico; Ibis Reproductive Health, Cambridge, Massachusetts; University of North Carolina School of Medicine, Chapel Hill, North Carolina; and Instituto Nacional de Salud Pública, Cuernavaca, Mexico

Address reprint requests to: Daniel Grossman, Population Council, Panzacola 62, Int. 102, Col. Villa Coyoacán, 04000, México, D.F., Mexico; e-mail: dgrossman{at}popcouncil.org.mx.

Routine follow-up visits after abortion are intended to confirm that the abortion is complete and to diagnose and treat complications. Many clinicians also take advantage of the follow-up visit to provide general reproductive health care: discussing contraceptive plans and providing family planning services; diagnosing sexually transmitted infections; performing a Pap test or discussing abnormal Pap results. We reviewed the evidence related to the routine postabortion follow-up visit. Other than mifepristone medical abortion performed at 50 days of gestation or later and methotrexate medical abortion, we found little evidence that mandatory follow-up visits typically detect conditions that women themselves could not be taught to recognize. In addition, the natural history of the most severe complications after abortion—infection and unrecognized ectopic pregnancy—have time courses inconsistent with the usual timing of the follow-up visit. Costs associated with this visit can be great. These include travel expenses, lost wages, child-care expenses, privacy and emotional burdens for women, and scheduling disruptions and the related opportunity costs caused by "no-shows" for the provider. Follow-up appointments should be scheduled for those women likely to benefit from a physical examination. For the remainder of women, simple instructions and advice about detecting complications, possibly coupled with telephone follow-up, might suffice. Although arguably valuable in their own right, counseling, family planning services, or sexually transmitted infection diagnosis and treatment should not be so inflexibly bundled with postabortion care. Protocols that require in-person follow-up after abortion may not make the best use of a women's time or abilities, or of the medical system.

This article has been cited by other articles:

				H. Hamoda, P. W. Ashok, G. M.M. Flett, and A. Templeton A randomized trial of mifepristone in combination with misoprostol administered sublingually or vaginally for medical abortion at 13-20 weeks gestation Hum. Reprod., August 1, 2005; 20(8): 2348 - 2354. [Abstract] [Full Text] [PDF]