Post-Abortion Care (PAC) 

Definition

Post-Abortion Care (PAC) is a package of services provided to women after a spontaneous or induced abortion, aimed at:

• Preventing complications

• Managing medical or surgical complications

• Providing counselling and contraceptive services

• Ensuring psychosocial support

PAC is safe when delivered by trained personnel in hygienic settings with appropriate equipment.

Service Provision Levels

• PAC can be offered at all levels of care, from health posts to tertiary hospitals, depending on the available skills and patient condition.

• All facilities must be registered with relevant regulatory authorities.

• Emergency preparedness must be in place at every facility offering PAC.

Assessment & Initial Stabilization

1. Clinical Assessment

   • Check vital signs to determine clinical stability

   • Identify life-threatening conditions:

     • Shock

     • Ectopic pregnancy

     • Sepsis

     • Severe hemorrhage

2. Emergency Measures

   • Initiate resuscitative measures immediately for unstable patients

   • Apply ABCD principles (Airway, Breathing, Circulation, Dehydration)

Physical Examination

• Pelvic examination to assess:

  • Vaginal bleeding

  • Vaginal discharge

  • Uterine size

  • Presence of retained products of conception (RPOC)

• Signs of infection:

  • Fever

  • Foul-smelling discharge

  • Tender uterus

Laboratory Investigations

• Take appropriate specimens if infection is suspected without delaying treatment

• Perform relevant lab tests:

  • Hemoglobin (HB)

  • Blood grouping and cross-match

  • Additional tests guided by patient’s medical condition

Management Principles

• Stabilize first, then assess and manage complications according to:

  • Local protocols

  • National Standards & Guidelines for Comprehensive Abortion Care in Zambia

Key Components of PAC:

1. Emergency Treatment – Resuscitation and stabilization

2. Treatment of complications – Hemorrhage, infection, incomplete abortion

3. Counselling – Emotional support and addressing psychosocial needs

4. Family Planning – Offer appropriate contraceptive methods

5. Referral – Timely referral to higher-level facilities when necessary

Summary / Key Points

1. PAC should be provided by trained providers in adequately equipped and hygienic facilities

2. Assessment must prioritize life-threatening conditions

3. Pelvic examination and laboratory tests are essential, but treatment should not be delayed for lab results if patient is unstable

4. Management should follow evidence-based protocols, addressing both physical and psychosocial needs

5. Emergency preparedness and referral systems must be in place at all levels