Short Term Complications and Other Aspects of Morbidity
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Incidence of Emergency Department Visits and Complications After Abortion. Upadhyay UD, Desai S, Zlidar V, Weitz TA, Grossman D, Anderson P, Taylor D. Obstet Gynecol. 2015 Jan;125(1):175-83. doi: 10.1097/AOG.0000000000000603.
OBJECTIVE: To conduct a retrospective observational cohort study to estimate the abortion complication rate, including those diagnosed or treated at emergency departments (EDs).
METHODS: Using 2009–2010 abortion data among women covered by the fee-for-service California Medicaid program and all subsequent health care for 6 weeks after having an abortion, we analyzed reasons for ED visits and estimated the abortion-related complication rate and the adjusted relative risk. Complications were defined as receiving an abortion-related diagnosis or treatment at any source of care within 6 weeks after an abortion. Major complications were defined as requiring hospital admission, surgery, or blood transfusion.
RESULTS: A total of 54,911 abortions among 50,273 fee-for-service Medi-Cal beneficiaries were identified. Among all abortions, 1 of 16 (6.4%, n=3,531) was followed by an ED visit within 6 weeks but only 1 of 115 (0.87%, n=478) resulted in an ED visit for an abortion-related complication. Approximately 1 of 5,491 (0.03%, n=15) involved ambulance transfers to EDs on the day of the abortion. The major complication rate was 0.23% (n=126, 1/436): 0.31% (n=35) for medication abortion, 0.16% (n=57) for first-trimester aspiration abortion, and 0.41% (n=34) for second-trimester or later procedures. The total abortion-related complication rate including all sources of care including EDs and the original abortion facility was 2.1% (n=1,156): 5.2% (n=588) for medication abortion, 1.3% (n=438) for first-trimester aspiration abortion, and 1.5% (n=130) for second-trimester or later procedures.
CONCLUSION: Abortion complication rates are comparable to previously published rates even when ED visits are included and there is no loss to follow-up. "Somatic Complications and Contraceptive Techniques Following Legal Abortion." G. Fried, E. Ostlund, C. Ullberg, M. Bygdeman, Acta Obstet Scand. 68:515-521,1989.
- In a study of 1000 women who had abortions in Stockholm, Sweden in 1987, 5.4% were reported to have complications in the form of infection, bleeding or incomplete abortion, fever at over 38 degrees centigrade (1.6%). About one half (2.8%) were re-admitted to the hospital.
Comments: This was a project of the abortion advocacy group Advancing New Standards in Reproductive Health (ANSIRH). (See their news release titled: "New ANSIRH study published in Obstetrics & Gynecology shows that major complications after abortion are extremely rare.") The authors actually found a very high rate of Emergency Department visits, 6.4% within just six weeks of the abortion . . . excluding urgent care visits. They did not offer a comparison of this rate of emergency room visits to the general population of Medi-Cal beneficaries, or even better, the ED visit rate of the same group of women during a six week period prior to their pregnancies. Though 6.4% had ED visits, the authors examined the payment codes for visits and made their own determination of whether or not the visit was for "abortion related" complications. It is clear that they did not include treatments for drug overdose, attempted suicide, or injuries due to self-destructive risk taking behavior (all of which have been observed to increase following an abortion).
Health services utilization after induced abortions in Ontario: a comparison between community clinics and hospitals. Ostbye T, Wenghofer EF, Woodward CA, Gold G, Craighead J. Am J Med Qual 2001 May-Jun;16(3):99-106
The purpose of this study was to compare postabortion health services utilization of hospital abortion patients with community clinic abortion patients using administrative databases. The study was a retrospective cohort study. The study group consisted of patients with induced abortions (n = 41,039) performed in hospitals or community clinics recorded in the 1995 Ontario Health Insurance Plan claims (OHIP) database. An age-matched cohort of 39,220 women who did not undergo induced abortions was selected from the same data source to serve as controls. The main outcome measures were health services utilization indicators constructed from OHIP data within 3 months postabortion from office consultations, emergency room consultations, and hospital admissions. Hospitalization indicators were constructed from Canadian Institute for Health Information hospital discharge data within 3 months postabortion and included data on hospitalizations for infection, certain surgical events, or psychiatric problems. Postabortion health services utilization and hospitalization were higher in the patient population, regardless of service location, than in the age-matched cohort. Within the abortion patient population, hospital day-surgery patients had higher rates of postabortion utilization and hospitalization than did community clinic patients. Multivariate analysis revealed that hospital day surgery patients had a higher risk of subsequent post-abortion hospitalizations for infections (odds ratio [OR] 1.67, 95% confidence interval [CI] 1.23-2.28), surgical events (OR 1.70, 95% CI 1.30-3.24) and psychiatric problems (OR 2.65, 95% CI 1.77-3.98) than community clinic patients. The rates of postabortion health services utilization and risk of hospitalization were lower in community clinic abortion patients than in hospital day-surgery patients. However, it is not possible to fully control for important confounding variables when using these administrative data.
"Complications of termination of pregnancy: a retrospective study of admissions to Christchurch Women's Hospital, 1989 and 1990," P. Sykes, New Zealand Medical Journal 106: 83-85, March 10,1993.
- A 1989-90 New Zealand study found an overall complication rate of 5.8% following induced abortion as measured by readmission of women. This included 2.9% who had retained products of conception. Immediate complications (0.92%) included perforation, hemorrhage and post-operative pain. Delayed complications were lower abdominal pain and vaginal bleeding presumed to be due to endometritis, retained products of conception or both.
"Early Complications After Induced First-Trimester Abortion," L Heisterberg and M Kringelbach, Acta Obstet Gynecol Scand 66:201-204, 1987
- A Danish study during 1980-85 reported 6.1% of women had postabortion complications requiring hospitalization.
"Induced abortions operations and their early sequelae," P.I. Frank, C.R. Kay, S.S. Wingrave, J. Royal College General Practitioners 35: 175, April, 1985
- A British study of 6105 women during 1976-79 found that the main factors independently affecting post abortion morbidity were the place of operation, gestation at termination, method of operation, sterilization at the the time of abortion and smoking habits. Morbidity rates were higher for abortion carried out under the National Health Service than in private practice. Overall newly presenting morbidity, as defined in the study, was reported in 16.9% of the patients (1031 patients) in the 21 days following abortion of which 10% (612 patients) was thought to be directly related to the abortion. Major complications as defined in the study were 2.1%.
"Women refused second-trimester abortion: correlates of pregnancy outcome," N. Binkin, C. Mhango, W. Cates, B. Slovis, M. Freeman, Am.J. Obstet Gynecol 145:279,1983.
- Among 50 women (86% black) who obtained legal abortions in Atlanta, Georgia after being denied abortion at Grady Memorial Hospital in 1978-79, 12% subsequently reported at least one complication including retained placenta, hemorrhage, pelvic infection or cervical or uterine injury when followed-up in 1980-81.
"Morbidity Risk Among Young Adolescents Undergoing Elective Abortion," R.T. Burkman, M.F. Atienza, T.M. King, Contraception 30 (2):99-105, Aug. 1984.
- In a study at Johns Hopkins Hospital of 399 adolescents (57.4% black) aged 17 or less at the time of their abortion matched to 399 women aged 20-29 years found that adolescents had a statistically significant relative risk of 2.5 of endometritis compared with women aged 20-29 (7% vs. 2.7%); 1.25% vs. 0.5% had cervical lacerations and 1.75% had hemorrhaging greater than 500 cc (same as controls). Approximately 4% of adolescents had preexisting cervical gonorrhea compared with 2.7% of women aged 20- 29.
"A New Problem in Adolescent Gynecology," M Bulfin, Southern Medical Journal72(8): 967-968, Aug 1979.
- Fifty-four teenage patients were seen with significant complications after legal abortion. None felt they had been afforded any meaningful information about the potential dangers of the abortion operation. Perforation of the uterus, peritonitis, pelvic pain, pelvic abscesses, bleeding and cramping, cervical lacerations, severe hemorrhage and adverse psychological and psychiatric sequelae were noted in various case reports.
"Pregnancy Complications Following Legally Induced Abortion," E. Obel, Acta Obstet. Gynecol. Scand., 58: 485-490 (1979).
- Bleeding before 28 weeks of gestation and retention of placenta or placental tissue occurred more frequently after an abortion than in a control group matched for age, parity and socio-economic status.
"Late Sequelae of Induced Abortion: Complications and Outcome of Pregnancy and Labor," S. Harlap and A.M. Davies, American Journal of Epidemiology, 102(3): 217-224 (1975).
- Seven hundred fifty-two mothers who were interviewed during a subsequent pregnancy, and who reported one or more induced abortions in the past, were more likely to report bleeding in each of the first three months of present pregnancy. They were subsequently less likely to have a normal delivery, and more of them needed a manual removal of the placenta or other intervention in the third stage of labor. A disturbing finding in this study is the excess of malformations in the births following earlier induced abortions.
"Intrauterine Adhesions Secondary to Elective Abortion," C. March and R. Israel, Obstetrics and Gynecology, 48 (4): 422-424 October 1976.
- Amenorrhea and/or infertility secondary to intrauterine adhesions (Asherman's syndrome) following elective abortion is a significant complication.
"Increased Reporting of Menstrual Symptoms Among Women Who Used Induced Abortion," L. Roht, M. Former, H. Aoyama and E. Fonner, American Journal of Obstetrics Gynecology, 127(4): 356-362 February 15,1977.
- D&C technique of abortion appears to create more menstrual disturbances - i.e., menorrhagia and lengthy or painful menses than vacuum aspiration. The broader array of excess symptoms reported by Japanese women suggests a psychic component as well. Japanese women who desire abortion will frequently travel to a different city or neighborhood to avoid friends or acquaintances. Japanese women apparently under report their prior abortion experience in interviews, compared with questionnaires answered anonymously and in the privacy of their homes.
"Morbidity and Mortality from Second Trimester Abortions," D. Grimes and K. Schulz, Journal of Reproductive Medicine, 30(7): 505-514 July 1985.
- Little information exists concerning the potential late sequelae of second-trimester abortion.