Woman-Centered Postabortion Care

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Woman-Centered Postabortion Care
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Follow-Up Care
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Purpose

• This module covers the knowledge, skills and
  attitudes health-care workers must have to follow
  up on physical complications, contraceptive
  services, emotional issues and other concerns
  after PAC and to provide preventive care and
  referrals for other services.

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Objectives

• At the end of this module, learners should be
  able to
• Explain the purpose of a PAC follow-up visit
• Discuss elements of a follow-up visit
• Assess physical status of the woman at follow-up
• Diagnose need and refer for sequelae of PAC

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Objectives (cont.)

• Identify psychosocial elements of follow-up visit
• Identify special populations with particular
  needs
• Recognize importance of offering contraceptive
  services during follow-up
• Identify reproductive-health referrals possible
  during follow-up

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Scheduling Follow-Up Visits

• Schedule before discharge from PAC facility
• Timing varies, usually within one week
• May not be at same PAC facility
• May refer her to provider in her community

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Women with Complications

• Some women present for PAC with complications
• Some women experience complications during PAC
• Other women experience complications after PAC

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Follow-Up Visit Women with Complications

• Ensure any complications have been resolved
• Stabilize, treat or refer women with acute
  problems

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Women Without Complications

• Opportunity for individualized counseling
• Opportunity for contraceptive services
• Opportunity to access resources to address other
  concerns

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Review Medical Records, Referral Documents with
the Woman
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Assess Physical Status

• Vital signs
• Any bleeding, fever
• Pain or cramps
• Medications taken (past and present)
• Anything in vagina since PAC intercourse
• Current contraceptive use
• Signs of physical abuse

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Perform a Pelvic Exam

• Assess uterine size, tone, tenderness
• Evaluate for retained POC, infection, continuing
  pregnancy
• Incomplete or continuing pregnancy re-evacuate
• Evaluate for STIs discomfort, tenderness,
  discharge

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Perform a Pelvic Exam (cont.)

• Adolescents or rape victims need special
  attention
• Offer reassurance use small speculum

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After Clinical Assessment

• Review any tests performed during PAC
• Manage any conditions

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Psychosocial Elements of PAC Follow-Up

• Evaluate her emotional status, support counsel
  or refer
• Assess her fertility goals, need for
  contraception
• Provide counseling, contraceptive method if
  desired

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Psychosocial Elements of PAC Follow-Up (cont.)

• Recurrent miscarriages refer to infertility
  services
• Refer for other needs

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Psychosocial Elements
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Contraceptive Services

• Women ovulate about 10 days after PAC
• All women should be asked about fertility goals
• If she wants to become pregnant, refer her for
  prenatal care

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Contraceptive Services (cont.)

• A woman may want a different method
• If she wants to be pregnant, she may have
  questions about fertility
• She may come for IUD/IUS or BTL

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Different Contraceptive Methods
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Linkages to Sexual- and Reproductive-Health
Services

• Services for STIs, HIV/AIDS
• Prenatal care for desired pregnancy
• Infertility services
• Services for women who have experienced violence

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Other Possible Linkages

• Referrals for female genital cutting (FGC)
• Counseling for nutrition
• Screening/referral for cancer
• Counseling and referral to adolescent-focused
  resources

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Illustrations by Stephen C. Edgerton