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 Physical Complications 


In looking at complications from abortion it may be helpful to understand something of the process first. This section will look at both Surgical Abortion (Suction Curettage) and EMA or Early Medical Abortion processes and complications.


1. Surgical Abortion - Suction Curettage


General Process

  • Referral to clinic or hospital by GP / Family Planning Association

  • Counselling offered, not compulsory

  • Scan usually to determine dates

  • 2 doctors to sign off – one a practising Obstetrician Gynaecologist

  • If opts for abortion, aim to complete by end first trimester

  • Procedure explained

  • Tablet given to soften cervix - sedation given

  • Operating theatre perform suction curettage

  • Observation for a few hours, cup of tea, home

  • 6 week follow up

    Note: Immediate complications dealt with by clinic or hospital staff.
            Incomplete termination usually requires a further operation Dilation & Curettage
            If further problems patient directed to go to GP

Complications

Physical complications may arise immediately after the operation or occur later. Immediate physical complications of uterine perforation, haemorrhage or septicaemia can be serious though rarely fatal.

When there are retained foetal or placental products from an incomplete abortion, then another operation (usually dilation and curettage) may be required to evacuate the uterus.(1)


Chronic or long term problems may include:

  • Gastro-intestinal Disturbances

  • Infection including

         - Pelvic Inflammatory Disease - Infertility

         - Endometritis

  • Problems with future pregnancies such as

         - Placenta praevia

         - Ectopic pregnancy

  • Cervical lacerations & cervical incompetence predisposing to

         - Premature delivery

         - Labour complications(2)

  •  Links between abortion and breast cancer are being made, although the research is conflicting


The following complications were reported by the Abortion Supervisory Committee for the 1999 year.

Number    Complication                                   
  1             Cervical Laceration Tear                      
 15            Perforation of the Uterus                     
 19            Haemorrhage 500 mls or more            
 25            Retained Placenta Tissue                         
   1            Failed Termination Requiring 2nd Procedure   
   1            Seizure                                              
   1            Pain Post-op                                          
  63           Total                                                 


Statistics fail to give an accurate picture of the extent of problems in the New Zealand population. Many of the physical problems associated with an abortion occur after the post-operative period and some become long-term problems which can be painful and upsetting for women. Women confront general practitioners with physical problems but often the possible connection to a recent or past abortion is neither explored nor registered.

References:

1. Complications of termination of pregnancy: a retrospective study of admissions to Christchurch Women’s Hospital, 1989 and 1990, NZ Medical Journal, March 1993
2. The Aftereffects of Abortion, http://www.afterabortion.org/complic.html

See also

"Considering Abortion" booklet, the Ministry of Health, NZ - goto http://www.moh.govt.nz/moh.nsf/pagesmh/1301?Open


2. Early Medical Abortion (EMA)

    (Notes from Mifepristone in Australasia Conference, Abortion Providers’ Conference, Wellington, October 2009)

Process

  • Decision phase

  • Scan to determine dates and exclude ectopic pregnancy, blood tests for a baseline HCG

  • Administration Mifepristone tabs – point of no return

    - takes time for Mifepristone to reach and be taken up by progesterone receptors

    - detachment of gestational sac and cervix opens

  • 5% expel before Misoprostol given, 24% 4-5 hours after, others more than 24 hours later

  • Keep interval between each as short as possible to decrease side effects

  • Misoprostol given usually 36-48 hours after first tablets

  • Once expulsion complete patient goes home or in some areas patient take medication on site and allowed to go home under certain conditions – has support, has phone, speaks English


Complications

  • Heavy bleeding normal, but if excessive requires intervention

  • Pain relief

  • Diarrhoea

  • Vomiting

  • If pregnancy  continues 70% will have miscarriage

  • Infection


Follow Up

  • 2-6 weeks later to check successful expulsion, exclude complications and for contraceptive counselling

  • Ultrasound performed and clinical findings e.g. HCG test most reliable &/or gynaecological examination

  • Expulsion complete from a medical TOP if there is less than 20% of initial value within 7-10 days

  • Expulsion complete from a surgical termination when 50% of HCG drops within 48 hours

  • If urine test inconclusive then blood tests are done

  
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