Pregnancy after Abortion: What to Expect?

Overview

If you are on a pregnancy journey after an abortion or are planning to become pregnant after such an experience, this article is tailored especially for you. Abortion is the loss or termination of pregnancy. It can be spontaneous (miscarriage) or induced. Abortion brings a range of physical and emotional changes. Therefore, embarking on a pregnancy journey after having undergone an abortion can introduce a multitude of profound effects that require careful consideration. In this article, we will explore post-abortion pregnancy, delving into essential aspects such as the different types of abortion, fertility, potential risks, and recommended precautions. 

Types of abortion

• Medical abortion: It involves using medications such as mifepristone and misoprostol for pregnancy termination
• Surgical abortion: It is a surgical removal of the embryo from the uterus by a healthcare provider. Vacuum aspiration (suction abortion), as well as dilation and curettage (D&C) abortions, are techniques used in surgical abortions

Abortion is typically induced within 20 weeks of conception, although in rare cases, it may be performed beyond this time frame. During the first trimester, medical abortion is the preferred method, while in the mid-trimester, surgical procedures are typically used for pregnancy termination.^1,2

Post-abortion health effects: What to expect?

Abortion is a sensitive issue; not everyone experiences the same side effects. Some may encounter no symptoms at all, while others may experience a range of post-abortion changes. These fluctuations can affect your mental and physical health; thus, understanding these variations is crucial to ensure that you can make well-informed decisions.

Post-abortion side effects and complications 

Physical effect

Here are the potential side effects and complications that can impact your physical well-being:^3,4

Side effects of abortion are generally mild and often resolve on their own. However, complications require hospitalisation and sometimes surgery and blood transfusion. There is no need to be worried about side effects since the possibility of complications is fairly low. Studies have shown that the rate of serious adverse effects following abortion can be as low as 0.23%.⁵

Mental effect 

Whether the pregnancy was unwanted or precious, you might experience a range of emotions:^6,7

• Depression
• Anxiety
• Feeling of guilt
• Grief on the loss 
• Sense of happiness
• Post-traumatic stress disorders, in rare cases
• A feeling of rejection from family
• Psychosocial fear related to abortion stigma

Emotional responses to abortion can differ significantly among individuals. The risk factors that can potentially influence women’s emotions are:⁶

• Long duration of conception
• Previous history of infertility
• History of multiple abortions in the past
• Physical abuse from a partner 
• Lack of family support

Therefore, counselling and support are required to deal with such touching aspects of abortion.

Hormonal effect

It is important to note that hormonal changes may be more prevalent after undergoing an abortion in the latter stages of pregnancy. Various pregnancy hormones and subsequent abortion can lead to dramatic hormonal shifts. Sometimes it might take time to return to pre-pregnancy levels. 

The hormones such as prolactin and progesterone released during the pregnancy can bring the following changes:⁸

• Secretion of milk from the breast
• Enlarged and engorged breast

Fertility and conception after abortion

According to studies, 34% of women start ovulating within three weeks after an abortion, while 78% within six weeks.⁹ Therefore, it is possible to get pregnant within the first month after an abortion.

However, the key concern is whether you are physically and emotionally prepared to become pregnant in a short time. It is advisable to allow your body to recover and heal completely for a healthy pregnancy in future. 

Factors influencing future pregnancies

In case you decide to conceive after an abortion, then knowing the factors that influence future pregnancies can help you prepare better. Here is more information addressing all these concerns:^10,11

• Advanced maternal age: As women age, the risk of pregnancy loss increases significantly, with a chance of 54% for those aged 45 and above
• Infections: The spread of infection to the ovaries and fallopian tubes during abortion procedures can cause infertility or ectopic pregnancy 
• Abortion in first pregnancy: It increases the risk of placenta-related complications, miscarriage, ectopic pregnancy, and repeat abortion 
• Pregnancy termination at an advanced stage: Procedures like cervical dilation and curettage may interfere with conception in the future
• Smoking: It can increase the possibility of spontaneous abortion 
• Social deprivation: Socially underprivileged women pose a threat to pregnancy termination

Potential risks during the pregnancy 

Understanding these known risks can help you prepare for any unplanned situation:¹¹

• Preterm delivery
• Pre-eclampsia
• Abruptio placenta
• Placenta previa
• Antepartum haemorrhage (vaginal bleeding occurring after the 20th week of gestation)
• Low-birth-weight baby

It is just as crucial to ensure a safe delivery as it is to conceive. Hence, it is essential to remain vigilant throughout your pregnancy journey.

How to conceive after abortion?

If you are trying to get pregnant and looking for ways to increase your chances of conceiving and having a healthy pregnancy, consider the following steps:

Discuss with your doctor 

• Whether your body is ready for conceiving or not?
• When should you plan for pregnancy after abortion?
• Is there any high-risk condition that might interfere with your future pregnancies?

Stay informed

• Get regular health check-ups before trying to conceive
• Increase your chances of getting pregnant by monitoring your ovulation
• Making smart choices, such as using an ovulation calculator and pregnancy calendar, is always a good idea

Follow a healthy diet and develop healthy habits

• Make sure to consume food that contains the necessary nutrients 
• Keep yourself free from stress and avoid negative emotions related to previous abortion
• Adopt healthy habits such as exercising and avoiding smoking and alcohol intake

Precautions and care after getting pregnant 

Experiencing a wide range of emotions, from nervousness to joy, is entirely normal when becoming pregnant after an abortion. Always remember that abortion can have complex reproductive outcomes. Here's what you need to know to make your pregnancy journey healthy and safe:

Antenatal care 

• Maintain regular follow-up appointments with your doctor once you become pregnant
• Attend regular antenatal check-ups and undergo screening tests
• Protect yourself from infections and take the recommended vaccines
• Maintain a healthy diet and lifestyle

Recognising the warning signs of spontaneous abortion² 

• Heavy vaginal bleeding
• Longer duration of vaginal bleeding
• Cramping pain in the lower abdomen
• Vaginal discharge

If you experience any clinical features that suggest an impending abortion, do not hesitate to contact your healthcare professional.

Emotional support and counselling

Having a baby after an abortion can be very challenging. There are mixed feelings of guilt, fear and relief. At such a crucial time, you need support from your family and the community to cope with the physical, hormonal and emotional change you are dealing with. You might find these suggestions helpful in managing your emotions:

• Talk to your family about your concerns
• Go through the pregnancy journey together with your partner 
• Seek help from pregnancy clinics to discuss problems faced during your pregnancy 
• Join community or support groups where you can interact with mothers facing similar issues
• Keep your stress levels low by doing light exercises

FAQs

Which method should I choose for pregnancy termination?

You should consult your doctor, as the answer may vary based on your individual circumstances. Medical termination of pregnancy has fewer adverse effects than surgical termination.¹¹ Therefore, it is the preferred choice of abortion. However, your doctor can give you the best advice based on your health, pregnancy stage, and previous reproductive history. 

Does abortion influence future pregnancy?

Abortion does not affect subsequent childbearing or future pregnancies. Yet, some underlying factors might influence the conception. Therefore, consult your doctor if you have any medical conditions that risk future pregnancies.

Does bleeding in early pregnancy mean miscarriage?

Light vaginal bleeding and spotting are common during early pregnancy, and it does not mean you have a miscarriage. Miscarriage and ectopic pregnancy usually present with heavy bleeding and cramping pain in the lower abdomen.

How early after an abortion can I get pregnant?

Previous abortion does not prevent you from becoming pregnant again relatively soon. It is generally recommended to wait until you have had one menstrual cycle before trying to conceive, as this can help determine your expected delivery date.

Studies have shown that attempting to conceive as early as three months after an abortion is not associated with an increase in miscarriage in subsequent pregnancies.¹²

Summary

• The loss of a pregnancy can occur spontaneously or through induced abortion. While induced abortion is generally a safe procedure, there are instances where life-threatening complications may require immediate hospitalisation and medical management
• It's important to note that previous abortion does not influence your future pregnancies, and you can give birth to a healthy baby without complications. However, certain factors, such as advanced maternal age and infections, can affect future pregnancies
• To best prepare for pregnancy, it's advisable to consult with your doctor. This includes taking routine health tests, staying informed, maintaining a healthy diet, and refraining from smoking
• Once you become pregnant, it's crucial to follow your doctor's advice, attend antenatal clinics, and promptly contact healthcare professionals if you experience any clinical signs that may suggest an impending abortion