Abstract

PIP: Grimes and Cates published an extensive review of the complications of induced abortion in 1979, and most of the information presented is extracted from their review. Numerous large studies have documented that abortion is a safe surgical procedure. Abortion morbidity is primarily affected by 2 factors: gestation age and abortion technique. Additional influencing factors are type of anesthesia used, concurrent sterilization, and pre-existing complications. The findings of the Center for Disease Control (CDC) Study -- total and major complications per 100 women, by gestation, procedure, sterilization, and anesthesia, for total patients and for patients with followup in the United States, 1971-1975 -- are presented in a 2nd table. Complications may be divided into immediate (developing within 3 hours of the procedure), delayed (developing from 3 hours to 28 days after the abortion), and late (occurring 28 days or more after the abortion). The immediate complication of uterine hemorrhage is difficult to evaluate because of inconsistent definitions and problems in estimating volumes of blood loss. Blood transfusion rates were reported as 0.06% for suction evacuation at 12 weeks, 0.19% for dilatation and evacutataion (D&E) at 13-20 weeks, and 1.53% for instilation of saline or prostaglandins at 13-24 weeks. Uterine perforation is a feared but rare complication of abortion procedure. A consistent rate of 0.2/1000 abortions had been reported from numerous institutions in the United States during the 2nd half of the decade. No consistent figures are available on the incidence of cervical injury. This is a potentially dangerous complication that may lead to life threatening hemorrhage or to the formation of fistulae. The risk of anesthesia-related complications from curettage abortion is 0.02/100 abortions with paracervical anesthesia. Retained products of conception remains 1 of the most important causes of abortion morbidity and may result in infection, bleeding, or both. There is a lack of uniform definitions and diagnostic criteria for post-abortal pelvic infection, which makes incidence rates difficult to interpret. Fever is 1 objective measure of the frequency of infectious morbidity, and incidence of fever by method is given. The death-to-case rate for abortion is lower than that for any other surgical procedure. The primary factors affecting mortality are period of gestation and type of procedure. Death-to-case rate for legal abortions by type of procedure and weeks' gestation is presented in table form. Suggestions for the prevention of complications are outlined.