Short-term complications after surgically induced abortions: a register-based study of 56 117 abortions

BACKGROUND

Performing an induced abortion is a rather simple medical procedure which is frequently done and side-effects will have public health implications unless they are very rare. We estimated the incidence of side-effects detected during the stay at the hospital and 2 weeks after the discharge. We only include side-effects reported by clinics or hospitals.

METHODS

Altogether 56 117 induced abortions performed by public hospitals in Denmark from 1980 to 1994 were analyzed in this study. The study combined results from the mandatory reporting of side-effects to the National Induced Abortion Registry and all diagnoses reported to the Hospital Discharge Registry.

RESULTS

Side-effects in the form of bleeding, infections or re-evacuation were recorded for about 5%. We found more side-effects in teenage women and for abortions performed late in pregnancy. We found nothing to indicate that the frequency of side-effects following an abortion changed over time.

CONCLUSIONS

About 5% have side-effects registered by hospitals following an induced abortion. The long-term consequences of this are not known.

A double-blind randomized study of the effect of erythromycin in preventing pelvic inflammatory disease after first trimester abortion

OBJECTIVE

To assess the prophylactic use of erythromycin in prevention of post-abortal pelvic inflammation disease (PID) in first trimester abortion.

DESIGN

Double-blind, randomized controlled trial.

SETTING

Department of Surgery, County Hospital, Denmark.

SUBJECTS

Four hundred and thirty two women who were to undergo induced abortion before 12 weeks gestation were randomized to be treated either with prophylactic erythromycin or a placebo.

INTERVENTION

The women were randomized to receive a placebo or erythromycin, 500 mg twice a day for 7 1/2 days starting the evening before the abortion. All the women were investigated for Chlamydia trachomatis and Neisseria gonorrhoea before the abortion.

MAIN OUTCOME MEASURES

Frequency of cervical C. trachomatis and N. gonorrhoea and frequency of PID after abortion.

RESULTS

Fifty four women were excluded after randomization. The frequency of PID was 11% (20/189) in the erythromycin group and 16% (30/189) in the placebo group (P = 0.13, chi 2-test). The prevalence of C. trachomatis was 19% (15/78) in women less than or equal to 20 years of age, 13% (14/109) in women between 21 and 25 years and 2% (5/241) in women greater than or equal to 26 years of age. In women positive for C. trachomatis erythromycin prophylaxis significantly reduced the frequency of PID to 8% (1/13) compared with 43% (6/14) in the placebo group (P = 0.051, logistic regression analysis). Erythromycin had no effect on other potential high risk groups (first pregnancy, nulliparous, less than 20 years of age, and women with previous PID).

CONCLUSION

Prophylactic erythromycin is not warranted for all women having an abortion. Cervical C. trachomatis is a risk factor for postabortal PID, and prophylaxis with erythromycin significantly reduces the frequency of PID. However, only a few women with PID had cervical C. trachomatis, and the prevention of post-abortal PID remains a major challenge requiring further studies.

General anaesthesia, a risk factor for complication following induced abortion?

Of the 10,000 abortions performed at the Regional hospital at Modena in Italy between 1982 and 1986, 199 (2%) led to early complications. Investigation of the relationship between the risk of haemorrhage, injury, other complications and all complications and eight explanatory variables revealed that the adjusted odds ratio associated with the use of general anaesthetic compared with local anaesthetic was 4.6 (95% CI, 2.2-9.5) for haemorrhage, 1.3 (95% CI, 0.78-2.2) for injury, 1.6 (95% CI, 1.0-2.6) for other complications and 1.8 (95% CI, 1.4-2.5) for all complications. It is speculated that if the relationship between use of general anaesthetic and risk of complication is causal there could be about 40% fewer cases of complications and 75% fewer cases of haemorrhage following induced abortion if local anaesthesia were used rather than general anaesthesia.

The risk of serious complications from induced abortion: do personal characteristics make a difference?

We examined the age, gestational age, parity, race, and number of previous spontaneous and induced abortions of 82,030 women who obtained abortions at less than or equal to 24 weeks' gestation. Among these women, 342 (0.4%) had serious complications, including 130 (0.2%) with fever greater than or equal to 38 degrees C for 3 or more days, 172 (0.2%) who required transfusions, 67 (0.1%) who required unintended surgery, and three who died. Factors significantly (p less than 0.05) associated with serious complications varied by period of gestation, including previous induced abortions (adjusted relative risk = 1.57, 95% confidence interval = 1.03 to 2.40) for procedures done at less than or equal to 12 weeks' gestation, advancing age (relative risk for a 5-year increment = 1.12, 95% confidence interval = 1.01 to 1.24), and advancing gestational age (relative risk for a 2-week increment = 1.50, 95% confidence interval = 1.43 to 1.57) for procedures done at greater than 12 weeks, and greater than or equal to 1 previous delivery (relative risk = 1.34, 95% confidence interval = 1.03 to 1.75) for all gestational ages. Although Hispanic women had higher rates of complications compared with white women, data were not available to control for socioeconomic status in comparing race groups. There was no significant association between previous spontaneous abortions and serious complications. Risk patterns were similar, but not identical, when fever, operation, and transfusion were considered separately.

Preventing febrile complications of suction curettage abortion

To identify risk factors for febrile complications after suction curettage abortion, we analyzed the data of 26,332 women who underwent suction curettage abortion at five participating centers in the Joint Program for the Study of Abortion, Part III, from 1975 to 1978. We defined febrile morbidity as an oral temperature of greater than or equal to 38 degrees C for 2 days or longer. The febrile morbidity rate was 0.34 per 100 abortions. We performed a multivariate analysis using a linear logistic regression model. Prophylactic antibiotics proved to be the most protective factor, reducing the rate of febrile complications to about one third that of women who received no prophylactic antibiotics (relative risk 0.36; 95% confidence interval 0.18 to 0.70). Patients who had had one or more previous births also had a significantly lower risk of febrile morbidity (relative risk 0.54; 95% confidence interval 0.33 to 0.88). Other factors did not significantly affect the febrile complication rate.

Repeat abortions: blaming the victims

A study of 1,505 women obtaining abortions in a freestanding abortion clinic in Western New York state revealed that women having repeat abortions were more likely to be using contraception at the time of conception than women having first abortions. However, nearly one-half the non-contracepting repeaters were not contracepting at the time of the repeat pregnancy. Repeaters who were not contracepting at the time of the repeat pregnancy listed medical contraindications or lack of supplies as the major reasons for not contracepting at the time of the present conception--indicating that they had tried one or more methods since their first abortion. Repeaters were sexually more active than first timers, thus increasing their statistical risk of unwanted pregnancy even as they contracepted more than first timers. The data indicate that both first timers and repeaters overwhelmingly reject the premise that abortion is a primary or even a back-up birth control method. The essential difficulty for repeaters appears to be that they are victims of technological, organizational, and logistical inadequacies as well as statistical probabilities rather than being motivationally deficient or indifferent to the dangers of unprotected sexual intercourse.