Infection after medical abortion

Infection of the upper genital tract after medical abortion occurs in around 0.11% of people undergoing medical abortion. However, international estimates vary from less than 0.1% (for severe infection requiring intravenous antibiotics in hospital) to 1% (for infections requiring treatment with oral antibiotics).

Infection generally presents later than 7 days after misoprostol is taken and can be associated with retained products of conception or an untreated sexually transmitted infection (STI). Unrecognised infection can progress to ascending infection and subsequent tubal scarring, or life-threatening sepsis.

Suspect infection if any of the following symptoms or signs are present:

• abdominal pain or tenderness
• abnormal vaginal discharge
• dyspareunia
• feeling unwell
• nausea, vomiting or diarrhoea
• temperature higher than 38°C
• uterine tenderness.

Refer immediately to an emergency department for moderate to severe infection. Features of moderate to severe infection include:

• lack of response to initial antibiotics
• severe pain
• systemic features (eg fever of at least 38°C, tachycardia, vomiting)
• sepsis or septic shock.

If results of screening tests for STIs performed before medical abortion were positive, or if an STI cannot be reliably excluded (eg if an STI could have been contracted since screening), treat as for pelvic inflammatory disease.

If an STI can be reliably excluded (ie results of STI screening were negative after an appropriate incubation period, and a subsequent STI could not have been contracted [eg no sexual activity since screening]), treat as for postpartum endometritis.