Complications related to induced abortion: a combined retrospective and longitudinal follow-up study

Abstract

Background: Induced abortion is one of the most common gynecological procedures in Sweden, but there is still little knowledge about the adverse effects. The aims of this study are to provide an overview of complications of medical and surgical abortions and to evaluate the impact of bacterial screening to prevent postabortal infections.

Methods: All women who underwent induced abortion at Skaraborg Hospital between 2008 and 2015 are included in the study. Bacterial screening for chlamydia, gonorrhea, mycoplasma, and bacterial vaginosis was performed prior to the abortions. Abortion complications, categorized as bleeding, infection, or incomplete abortion were assessed in women who came in contact with the gynecological clinic within 30 days after the procedure.

Results: A total of 4945 induced abortions were performed during the study period. Nearly all, 4945 (99.7%) were eligible for inclusion in the study. Medical abortions < 12 weeks were the most common procedure (74.7%), followed by surgical abortions (17.5%), and medical abortion > 12 weeks (7.8%). Complications were registered in 333 (6.7%) of all abortions. Among medical abortions < 12 weeks, the complication frequency increased significantly, from 4.2% in 2008 to 8.2% in 2015 (RR 1.49, 95% 1.04-2.15). An incomplete abortion was the most common complication related to medical abortions < 12 weeks. Of all women who tested positive for one or several bacteria at the screening and therefore received antibiotics, 1.4% developed a postabortal infection. Among those who tested negative at the screening, 1.7% developed infectious complications.

Conclusions: The share of complications related to medical abortions < 12 weeks increased significantly during 2008-2015 without any evident cause. Women who tested positive for one or several bacteria upon screening and received antibiotics experienced almost an equal proportion of postabortal infections compared to women who tested negative upon screening. The screening process seems to fulfill its purpose of reducing the risk of infectious complications.

Keywords: Endometritis; Induced abortion; Pregnancy; Sexually transmitted diseases; Vacuum curettage.

Fig. 1

Number of induced abortions per year from 2008 to 2015 at Skaraborg Hospital. The total number of abortions per year is illustrated together with the three different abortion methods: medical abortion > 12 weeks, medical abortion < 12 weeks and surgical abortion. Data from 2008 to 2012 include the clinics in Skövde, Falköping, and Mariestad. Lidköping’s hospital was added to the statistics in 2013

Fig. 2

Complication frequency among medical abortions < 12 weeks in Skaraborg i 2008–2015. The diagram shows separate graphs for incomplete abortions, bleeding, infections, and the total complication frequency

Fig. 3

Complication frequency among surgical abortions in Skaraborg in 2008–2015. The diagram shows separate graphs for incomplete abortions, bleeding, infections, and the total complication frequency

Fig. 4

Prevalence of chlamydia, mycoplasma, and bacterial vaginosis upon bacterial screening