Abstract

PIP: Singapore's liberal abortion laws have led to a marked decrease in morbidity and mortality from septic abortion; motality from legal abortion is very low. With over 17,000 abortions performed each year in Singapore, this discussion reviews the more common complications of the various procedures and considers how morbidity can be further reduced. Some of the major factors associated with an increased complication rate for abortion are: incorrect estimation of gestation; delay before operation; failure to detect medical of gynecological complications preoperatively; faulty operative technique; unsatisfactory conditions and equipment; and inadequate follow-up. 1 major approach for reducing morbidity from abortion should be in health education since both the mortality and morbidity of abortion are 10 times higher if the procedure is delayed to the 2nd trimester. Many of the other problems would be reduced if the doctors who perform abortions have had suitable clinical experience and the facilities in clinics are adequate. The complications of abortioon often depend on the procedure used for termination which in turn depends on the gestation of the pregnancy. Menstrual regulation covers all the procedures where abortion is induced before the end of the 6th week after the last menstrual period. Urinary pregnancy tests are inaccurate at this gestation stage and studies have shown that if menstrual regulation is performed on a clinical history alone 1/3 or more of the patients will be found not to have been pregnant if the evacuated material is histologically examined. The main complications of both medical and surgical techniques for menstrual induction are incomplete evacuation and continuing pregnancy. Suction termination of pregnancy has now replaced dilation and curettage because it is more effective for 1st trimester abortion and has a lower morbidity. In a Singapore series there was 4.8% overall complication rate with postabortal bleeding (2.5%) and pelvic inflammatory disease (1.9%) being the most common problems encountered. The 3 major early complications of 1st trimester abortion are continued vaginal bleeding, infection, and continuing pregnancy. Both bleeding and infection are more common if evacuation is incomplete. Since the morbidity and mortality of 2nd trimester abortion is 10 times that of 1st trimester abortion a major reduction in abortion complications could be achieved if the number of patients presenting after the 12th week of gestation could be reduced.