Remarks

• The decision about the mode of management of incomplete abortion should be based on the individual’s clinical condition and preference for treatment.
• Expectant management of incomplete abortion can be as effective as misoprostol; it can be offered as an option on the condition that the woman, girl or other pregnant person is informed of the longer time for expulsion of the pregnancy tissue and the increased risk of incomplete emptying of the uterus.
• Recommendation 35 was extrapolated from research conducted in women with reported spontaneous abortion. * Misoprostol can be repeated at the noted interval as needed to achieve success of the abortion process. At gestational ages ≥ 14 weeks, providers should use caution and clinical judgement to decide the maximum number of doses of misoprostol in pregnant individuals with prior uterine incision. Uterine rupture is a rare complication; clinical judgement and health system preparedness for emergency management of uterine rupture must be considered with advanced gestational age.

Implementation considerations

• Restrictions on prescribing authority for some categories of providers may need to be modified or other mechanisms put in place for making the medicines available for these providers within the regulatory framework of the health system.
• The evacuation of retained products is a signal function of basic emergency obstetric care (EmOC); thus training and implementation of these tasks can be integrated with EmOC services.

KEY HUMAN RIGHTS CONSIDERATIONS RELEVANT TO MANAGEMENT OF INCOMPLETE ABORTION

• States must ensure adequate access to essential medicines in an affordable and nondiscriminatory manner.
• Regardless of whether abortion is legal, States are required to ensure access to postabortion care where it is needed.
• Post-abortion care must be available on a confidential basis, including in situations where abortion is illegal.
• Post-abortion care must be available without the threat of criminal prosecution or punitive measures. States must not require health workers to report persons suspected of undertaking unlawful abortion, or require them to provide any potentially incriminating information during or as a prerequisite to receiving post-abortion care. For further information and sources, please refer to Box 1.2 and Web annex A: Key international human rights standards on abortion.