Haemorrhage after medical abortion

Haemorrhage is usually caused by retained products of conception, but uncommon causes (eg concurrent ectopic pregnancy, trophoblastic disease and placenta accreta) must be considered. If any of the following features is present at any time during or after medical abortion, immediate transfer to an emergency department is required:

• bleeding filling more than two large pads per hour for more than 2 hours in a row
• passing clots the size of a small lemon or larger
• feeling faint and perceiving the bleeding as heavy, even if the individual is not sure of the amount of blood being lost.

Emergency management may include blood transfusion; this is required in 0.13% of individuals after medical abortion.