CLINICAL BUSINESS RULE
COVER SHEET
Sydney/Sydney Eye Hospitals
TYPE OF DOCUMENT
FUNCTIONAL GROUP/SUBGROUP
DATE OF PUBLICATION
RISK RATING
REVIEW DATE
FORMER REFERENCE(S)
EXECUTIVE SPONSOR or
EXECUTIVE CLINICAL SPONSOR
AUTHOR
Follow Up
Clinical Business Rule
Clinical Patient Services
15th July 2013
Low
May 2016
Nil
Dr Anna McNulty Director of Sydney
Sexual Health Centre
Leanne Burton
Ruthy McIver
KEY TERMS Post Termination of Pregnancy
SUMMARY This document provides procedural guidelines for post termination of pregnancy follow up at SSHC.
Feedback about this document can be sent to powhpolicy@sesiahs.health.nsw.gov.au

CLINICAL BUSINESS RULE
Sydney/Sydney Eye Hospitals
<Title of Clinical Business Rule>
1. PURPOSE & SCOPE
The purpose of this document is to provide information and procedural guidelines related to post termination of pregnancy follow up on clients attending SSHC. Follow up is generally managed by the clinic that performed the termination but, if required, post termination follow up at SSHC can be offered to:

Women who work in the sex industry

Women who identify as Aboriginal or Torres Strait Islander

Women who report injected drug use

Youth (18 to 25 years old)

Women living with HIV/AIDS
Women who do not belong to these groups can be referred back to the termination clinic, their general practitioner or the NSW Family Planning Association.
2. RESPONSIBILITIES
Sydney Hospital Executive Policy and Procedure Committee
Policy Co-ordinator
SSHC Clinical Services Committee
Appropriate Line Manager
SSHC Policy Guardian
All employees, contractors and other health care providers of SSHC
3. DEFINITIONS
Definition of NHMRC grades of recommendations
Grade of
Recommendation
A
Description
Body of evidence can be trusted to guide practice
B Body of evidence can be trusted to guide practice in most situations
C
D
Body of evidence provides some support for recommendation(s) but care should be taken in its application
Body of evidence is weak and recommendation must be applied with caution
B-hCG – Beta Human Chorionic Gonadotropin
SSHC
– Sydney Sexual Health Centre
4. COMPETENCY/ASSESSMENT
N/A
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CLINICAL BUSINESS RULE
Sydney/Sydney Eye Hospitals
<Title of Clinical Business Rule>
5. CLINICAL BUSINESS RULE
5.1 Post Termination of Pregnancy Follow Up
Post termination follow up is recommended two weeks following the termination of pregnancy (1). The post termination follow up will be directed by the type of termination performed (i.e. medical, surgical or a combination of the two), the number of weeks gestation at the time of termination, and clinical presentation. A discharge letter from the termination clinic will note required follow up (1).
Like most post-operative checks, the routine post termination follow up will be normal for more than 95 percent of patients (1).
5.1.1 Clinical Presentation
Refer to relevant clinical guidelines in this manual. Nurses should consult with medical officers as per clinic protocol for the Delegation of Clinical Practices ( see section 8 in this document).
Expected Presentation
Surgical Termination
Per Vaginal
Bleeding

light bleeding may occur for up to2 weeks

usually dark and brownish

bright red blood 3 to 6days after termination can also be expected

there may be no bleeding at all
Discharge 
physiological discharge
Pain

mild, period-like cramps are common for3 days post termination

rest, hot water bottles, and analgesics may be helpful
Other symptoms

symptoms of pregnancy (e.g. nausea, breast tenderness) should resolve within 7days
Medical Termination

Bleeding is expected

average duration of bleeding is 9 to 12 days
 physiological discharge
 cramping may be mild or severe and is expected
 rest, hot water bottles and analgesics (particularly NSAIDS) may be helpful
 nausea, vomiting, diarrhoea, fever and chills may occur but are mild and shortlived
 symptoms of pregnancy should resolve within 7 days
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Emotional
Status

relief, regret and/or sadness generally occur 2 to 6 days after procedure or not at all

expect individual variations in emotional response
 relief, regret and/or sadness generally occur 2 to 6 days after procedure or not at all
 expect individual variations in emotional response
Presentations Requiring Further Investigation
Nausea and breast tenderness should resolve by day 7 post medical and surgical termination. If symptoms of pregnancy persist after 7 days, consider a quantitative hCG, a repeat visit for urine hCG and/or a pelvic ultrasound. Note that a urine test may remain positive even if the termination was successful.
Pain, bleeding or discharge outside of expected presentation should be investigated as per relevant clinical procedure. See section 8 of this document.
5.1.2 Post Termination History
The emphasis of a post termination follow up should be on eliciting a relevant history including a history of pelvic pain, vaginal bleeding, continued symptoms of pregnancy and emotional status. Relevant questions may include:

Date of termination and type preformed

Length of gestation at termination

Antibiotic course duration and completion, if prescribed

Does she feel well?

Per vaginal bleeding, pain and/or discharge

Symptoms of continued pregnancy (e.g. nausea, breast tenderness)

Emotional status

Contraception counselling
5.1.3 Referral Services and Resources:
Consider an internal Counselling Referral if protracted sadness or excessive regret are identified. The following external resources may also be helpful:
Depression:
Black Dog Institute (http://www.blackdoginstitute.org.au)
Beyond Blue ( http://www.beyondblue.org.au/get-support/get-immediate-support )
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CLINICAL BUSINESS RULE
Sydney/Sydney Eye Hospitals
<Title of Clinical Business Rule>
Family Planning/Contraception :
Family Planning Association of NSW (http://www.fpnsw.org.au/)
Unplanned Pregnancy Counselling
Childrenbychoice (http://www.childrenbychoice.org.au/)
6. DOCUMENTATION
Refer to Section C14 - NSW_SHS_SOP_2011.pdf
All patient consultations including examinations and tests collected are to be documented on the SSHC Medical Record proforma.
7. COMPLIANCE EVALUATION
SSHC policies are reviewed 3 yearly. Adherence is monitored through ongoing medical record audit process.
8. RELATED POLICIES/PROCEDURES/GUIDELINES/BUSINESS RULES
SSHC Clinical Business Rules: Contraception
SSHC Clinical Business Rules: Counselling Referrals
SSHC Clinical Business Rules: Delegation of Clinical Practice
SSHC Clinical Business Rules: Female Genital Exam
SSHC Clinical Business Rules: Pelvic Inflammatory Disease
9. EXTERNAL REFERENCES
Number Reference
1
2
Family Planning NSW (2011). Reproductive and sexual health: an Australian clinical practice handbook. 2 nd Ed. Australia, NSW
Royal Australian and New Zealand college of Obstetritions and
Gynaecologists (2005). Termination of pregnancy: A resource for health professionals. Available at: http://www.ranzcog.edu.au/publication/womenshealth-publications/termination-of-pregnancy-booklet.html
. Accessed on 29
May 2013.
10. REVISION & APPROVAL HISTORY
Date
01/05/2007
Revision No. Author and Approval
3 Leanne Burton
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CLINICAL BUSINESS RULE
Sydney/Sydney Eye Hospitals
<Title of Clinical Business Rule>
April 2010 4
July 15,
2013
5
Leanne Burton
Ruthy McIver
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