The concern about whether a pregnancy can continue after an abortion is a common worry for people undergoing the procedure, though a successful outcome is the norm. Abortion procedures, whether medical or surgical, are highly effective, with success rates typically exceeding 95%. When questions arise about the procedure’s success, they usually stem from a misunderstanding of how the body recovers or from the rare complication where pregnancy is not fully terminated. This article provides clarity on the clinical signs and medical steps that confirm a successful termination.
Defining Incomplete Abortion
The technical possibility of a continued pregnancy is often related to the concept of an incomplete abortion. An incomplete abortion occurs when not all of the pregnancy tissue is expelled from the uterus. This retained tissue can cause ongoing symptoms and requires medical intervention to prevent complications such as infection or hemorrhage.
It is important to distinguish between retained tissue and a truly viable, ongoing pregnancy. Retained tissue is non-viable and does not mean the pregnancy is still growing, but it indicates the procedure was technically incomplete. A truly failed procedure, where a viable fetus continues to develop, is extremely rare. The risk of a continuing viable pregnancy is slightly higher with medical abortion compared to surgical abortion, which is why proper follow-up is necessary.
Symptoms Immediately Following the Procedure
The first indications of a successful procedure are the expected physical changes that occur immediately afterward. Common post-abortion symptoms include cramping and vaginal bleeding, which are signs that the uterus is contracting to expel the tissue and return to its non-pregnant state. The bleeding may be heavy initially, especially with a medical abortion, and may involve passing blood clots, which is normal.
Conversely, the physical symptoms of pregnancy should begin to rapidly diminish following a successful procedure. Hormonal effects like breast tenderness, nausea, and morning sickness typically start to subside within a few days to a week. A persistent feeling of being pregnant or a return of strong pregnancy symptoms warrants medical evaluation, as it can be a sign that the procedure was not fully successful. Elevated pregnancy hormones can sometimes linger for weeks, causing mild residual symptoms even when the termination is complete.
Medical Confirmation of Success
Objective medical confirmation is the definitive way to ensure the abortion is complete. The most common method involves monitoring the levels of the pregnancy hormone, human chorionic gonadotropin (hCG), in the blood or urine. Since hCG levels drop gradually after the procedure, an immediate standard pregnancy test is unreliable and may show a false positive for up to four weeks.
hCG Testing
Healthcare providers often use quantitative serum hCG testing to track the hormone’s decline from the pre-treatment level. A successful abortion is indicated by an hCG level that has fallen by 80% or more within the first week after the procedure. Another reliable strategy is checking the serum hCG level 14 to 21 days after the procedure; a level below a certain threshold, such as 900 IU/L, strongly excludes an ongoing pregnancy.
Ultrasound Examination
An ultrasound examination provides visual confirmation that the uterine cavity is empty of pregnancy tissue. This method is quick and reliable for assessing the outcome. It is not always required if the patient’s symptoms are resolving as expected. In some cases, a combination of falling hCG levels and clinical assessment is used to confirm success, avoiding the need for an in-clinic ultrasound.
Necessary Follow-Up and Safety
A follow-up appointment, typically scheduled one to three weeks after the procedure, is necessary to ensure the abortion is complete and that recovery is progressing without complication. During this appointment, the provider assesses symptom resolution and may perform confirmation methods, such as an ultrasound or hCG test, if the outcome is in doubt. This appointment also provides an opportunity to discuss contraception and address any emotional concerns.
Immediate medical attention is required if warning signs appear before the scheduled follow-up:
- Soaking two or more maxi pads per hour for two consecutive hours, signaling excessive blood loss.
- Severe, persistent abdominal pain that is not relieved by medication.
- A fever of 100.4°F or higher lasting more than four hours.
- A foul-smelling vaginal discharge, which may indicate infection or an incomplete abortion.