SAFETY
& COMPLICATIONS OF ABORTION
Physical
Effects
With
medical abortion, the most common side effects come from
misoprostol. Misoprostol is the medication taken after
either methotrexate or mifepristone. It causes the uterus
to contract and empty. Side effects may include headache
and nausea, vomiting and diarrhea, strong cramps and heavy
bleeding. The amount of bleeding after medical abortion
is greater than after surgical abortion. Bleeding lasts
from 4-40 days. In most cases, however, bleeding stops
after 10 days. Some women require mild painkillers.
During
surgical abortion, most women feel pain similar to menstrual
cramps. Others experience greater discomfort despite the
use of local painkillers. After the procedure, a woman
may continue to have cramps and some bleeding. Most, however,
are able to return to work and normal activities the next
day.
Emotional
Effects
Women
end pregnancy for a variety of reasons. After abortion,
many women describe feeling relief. Often there may be feelings
of guilt, sadness, or loss as well. Mixed emotions are
common. In fact, 70% of women who undergo abortion disclose
a desire to have children sometime in the future. In addition,
the circumstances that led to the decision to abort still
may cause distress.
Despite
all this, fewer than 20% of women report depressive symptoms
immediately following an abortion. Most report that these
are mild and transient in nature. Depressed mood may also
be in part, biologically based. Ending pregnancy causes
an abrupt change and drop in hormone levels. After thoughtful
investigation, the American Psychological Association has
concluded that there is no scientific evidence or support
for severe psychological trauma induced by abortion.
Procedure
Safety
The
earlier an abortion is performed, the less complicated and
safer it tends to be. Less than 1% of women who undergo
legal abortion have a serious complication, but complication
rates do increase with the length of pregnancy. Most complications
occur within a few days after the abortion. Others can
occur during the procedure or much later.
Overall,
abortion has a low mortality rate. Currently, there is less
than one death for every 100,000 procedures at every stage
of gestation. In the first 20 weeks, getting an abortion
is actually much safer than giving birth. In fact, the
risk of death associated with childbirth is up to 10 times
as high as that associated with abortion. The leading cause
of death associated with induced abortion is anesthetic
complications. This is followed by hemorrhage, embolism,
and infection.
In
addition to the length of pregnancy, there are a variety
of other factors that can affect the rate of complications.
These are skill and training of provider, type of anesthesia,
woman’s overall health, and the abortion method used.
Complications from abortion include:
Infection:
Infection
occurs in less than 3% of surgical abortions. Induction
terminations have been associated with a slightly greater
risk of 5-6%. This may be due to retained pregnancy tissue
left in the uterus. Antibiotics given before the procedure
can help reduce the risk. Signs of infection include chills
or fever of 100.5F or higher, bad cramping, excessive bleeding,
and/or vaginal discharge with a foul odor. With prompt
identification and antibiotic treatment, the infection usually
clears up without need for further intervention. If left
untreated, infection can lead to serious illness, sterility,
and even death.
Retained
tissue: An
incomplete abortion occurs when tissue from pregnancy remains
in the uterus. This occurs in about 1-2% of all cases.
Retained tissue can become infected. Signs of incomplete
abortion include bleeding that is very heavy, lasts more
than three weeks, or involves passage of large blood clots.
Strong cramps or continued signs of pregnancy (sore breasts,
nausea, etc.) after one week also indicate retained tissue.
Treatment may include drugs to stimulate the uterus to contract
and empty, or tissue removal by aspiration.
Hemorrhage:
The
risk of hemorrhage or excessive bleeding from the uterus
is 1-2%. This can be caused by a number of factors. The
most common cause is the failure of the uterus to contract.
This is more likely to occur in second trimester abortions.
Other reasons for very heavy bleeding are retained tissue
or perforation. Treatment may include medication to stimulate
the uterus to contract, surgical abortion, or surgery.
Blood transfusions are required in rare cases.
Hematometra:
Hematometra
is when blood or blood clots accumulate in the uterus.
This happens in up to 1% of abortions. It occurs when the
uterus does not contract properly or when a blood clot blocks
the cervix. Signs include decreased vaginal bleeding and
a swollen, tender uterus. Worsening pain, cramping, and
nausea are sometimes associated. Clots need to be removed
by repeat aspiration or curettage.
Uterine
Perforation:A
perforation is a puncture or tear in the wall of an organ.
There is a less than 0.5% risk that an instrument will go
through the uterine wall during surgical abortion. Serious
consequences include hemorrhage or damage to other organs
such as the bowel. Many perforations heal by themselves.
Few require surgical repair, or very rarely, hysterectomy.
A higher risk of perforation is associated with multiparity
(many deliveries), advanced gestational age, and operator
inexperience. By relaxing the uterine muscles, and thus
making them more vulnerable to penetration, general anesthesia
is also associated with a higher risk of perforation.
Cervical
Laceration: A
cut or tear in the cervix occurs in less than 1% of cases.
As with uterine perforations, cervical lacerations generally
self-heal. Stitches are not usually required. Cervical
tears are also more likely to occur with the use of general
anesthesia for the same reasons that uterine perforation
is more frequent. Therefore, sedation with local anesthesia
is usually used for surgical abortion.
Continued
Pregnancy:
A continued pregnancy after surgical abortion –
sometimes called a missed abortion – happens in less
than 0.5% of abortions. It can occur in very early abortions
(less than six weeks after the last menstrual period) or
when there is a multiple pregnancy (twins, triplets, etc.).
In this case, abortion will have to be repeated.
Possible
effects on Future Pregnancies:
Having an abortion does not necessarily lower the likelihood
of having a healthy baby in the future. More specifically,
uncomplicated legal abortion does not increase the risk
of infertility, miscarriage, or ectopic (tubal) pregnancy.
When a woman has Rh-type blood, medicine is given after
an abortion to protect future pregnancies. There is limited
study on the effect of multiple abortions.
