Elective abortion. Complications seen in a free-standing clinic

Abstract

Experience is reported with the elective first trimester abortion of 16,410 pregnancies during a 31-month period by Reproductive Health Services of St. Louis, a free-standing clinic. Incidence of complications was 1.54%. The most common of these were incomplete evacuation, excessive postabortal bleeding, and uterine perforation. In patients with unquestioned perforation, the use of laparoscopy has been very valuable in ascertaining the exact nature of the perforation, in avoiding unnecessary laparotomy, and in giving intraabdominal visual guidance to concomitant suction evacuation in cases of an incomplete procedure. Aspects of the other complications are also discussed. In general, the findings support the view that even in the first trimester, the earlier in pregnancy that suction abortion is performed, the less likely it is to result in major complications. It is possible to perform first trimester abortions in a free-standing clinic with a satisfactorily low complication rate.

PIP: In elective first trimester of 16,410 pregnancies between June 1973-January 1976 at Reproductive Health Services of St. Louis, incidence of complications was 1.54%. The most common complication (32% of total complications) was incomplete evacuation of the uterus. Perforations of the uterus occurred in 34 patients (.2%); 1/3 of the perforations occurred in primigravidas. Excessive postabortal bleeding occurred in 41 patients and cervical lacerations in 22. 11 patients developed postabortal syndrome (PAS). In patients with unquestioned perforation, the use of laparoscopy is valuable in ascertaining the exact nature of the perforation, in avoiding unnecessary laparotomy, and in giving intraabdominal visual guidance to concomitant suction evacuation in cases of an incomplete procedure. The earlier that suction abortion is performed, the less likely it is to result in major complications; 56% of the complications occurred after the 10th week of pregnancy which represented 36% of the total procedures.