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Routine Follow-up Visits After First-Trimester Induced Abortion

Grossman, Daniel MD*; Ellertson, Charlotte PhD; Grimes, David A. MD; Walker, Dilys MD§

doi: 10.1097/01.AOG.0000115511.14004.19
Current Commentary

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.

For most women routine follow-up visits after aspiration or medical abortion are neither necessary nor useful.

*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:

This research was funded by Ibis Reproductive Health, the Population Council, and an anonymous donor.

Received August 11, 2003. Received in revised form December 7, 2003. Accepted December 11, 2003.

© 2004 The American College of Obstetricians and Gynecologists