Post-abortion Complications: A Narrative Review for Emergency Clinicians

Abstract

An abortion is a procedure defined by termination of pregnancy, most commonly performed in the first or second trimester. There are several means of classification, but the most important includes whether the abortion was maternally "safe" (performed in a safe, clean environment with experienced providers and no legal restrictions) or "unsafe" (performed with hazardous materials and techniques, by person without the needed skills, or in an environment where minimal medical standards are not met). Complication rates depend on the procedure type, gestational age, patient comorbidities, clinician experience, and most importantly, whether the abortion is safe or unsafe. Safe abortions have significantly lower complication rates compared to unsafe abortions. Complications include bleeding, retained products of conception, retained cervical dilator, uterine perforation, amniotic fluid embolism, misoprostol toxicity, and endometritis. Mortality rates for safe abortions are less than 0.2%, compared to unsafe abortion rates that range between 4.7-13.2%. History and physical examination are integral components in recognizing complications of safe and unsafe abortions, with management dependent upon the diagnosis. This narrative review provides a focused overview of post-abortion complications for emergency clinicians.

Figure 1

Ultrasound showing evidence of retained products of conception, demonstrated by echogenic, heterogeneous, and vascular intrauterine contents. Case courtesy of Dr Alexandra Stanislavsky, Radiopaedia.org, rID: 13852. Accessed at https://radiopaedia.org/cases/retained-products-of-conception-2?lang=us.

Figure 2

Ultrasound demonstrating pelvic free fluid and rising gas bubbles, indicative of uterine perforation. Image courtesy of Robert Jones, DO, POCUS Atlas. Available at https://www.thepocusatlas.com/ob-gyn-atlas.

Figure 3

Computed tomography demonstrating a) fluid collection anterior to the uterus that communicates with the endometrial cavity and b) defect in the anterior wall of the uterus. Case courtesy of Dr Hidayatullah Hamidi, Radiopaedia.org, rID: 90743. Available at https://radiopaedia.org/cases/uterine-rupture-with-postpartum-infection?lang=us.