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Complications of abortion

The chance of complications depends on many factors. The most important factor is how far along the pregnancy is. The risk of maternal death is 0.4 per 100,000 for early abortions up to 1 in 6,000 for later induction abortions.

With first trimester abortions:

• 97 percent of women have no complications or post-abortion complaints.
• 2-1/2 percent have minor complications that can be handled at the physician’s office, and less than 1 percent require additional surgical procedure and/or hospitalization.

First trimester abortion complications may include:

• Allergic reactions to anesthetics or other medications. Reactions may produce a fever, rash, and discomfort or in rare cases, may be life-threatening and require a hospital stay.
• Blood clots in the uterus. Large clots occur in about 1 percent of all abortions and must be removed by the doctor.
• Infections. Fewer than 1 percent of women who have an abortion become infected and must be treated with antibiotics. If not treated, infections may cause infertility or, in rare cases, be life-threatening and require hospitalization.
• A cut or torn cervix. Cervical damage occurs in fewer than 1 percent of all abortions. Stitches may be required. There may be increased risk for premature delivery in future pregnancies.
• Perforation of the wall of the uterus and/or other organs. Perforation occurs in fewer than 1 out of 1,000 early abortions. It is marked by heavy bleeding and pain. If bleeding can not be stopped, the uterus may be removed.
  Incomplete abortion occurs in less then 1 percent of abortions and requires a second procedure to complete the abortion.
• Heavy bleeding that requires medical treatment. Occurs in fewer than 1 in 1,000 procedures and may requires a blood transfusion or a hospital stay.

With second trimester abortions:

In the second trimester, complication rates are somewhat higher. Other significant factors that affect the possibility of complications include:

• the skill of the physician
• the kind of anesthesia used,
• the woman’s health, and
• the abortion method used.

Possible complication of a second trimester dilatation and evacuation procedure can include:

• Allergic reactions to anesthetics or other medications. Reactions may produce a fever, rash, and discomfort or in rare cases, may be life-threatening and require a hospital stay.
• General anesthesia is slightly more risky than local anesthetic.
• Infections. Fewer than 1 percent of women become infected and must be treated with antibiotics. If not treated, infections may cause infertility or, in rare instances, be life-threatening and require a hospital stay.
• Perforation of the uterus and/or other organs. Perforation occurs in 3 of every 1,000 abortions performed by the dilatation and evacuation procedure and is marked by heavy bleeding and pain. Perforation requires surgery to repair. If bleeding cannot be stopped, the uterus may be removed. In rare instances, this complication may be life-threatening.
• Injury to the cervix. Stitches may be required. Injury to the cervix may increase the risk for premature delivery in future pregnancies.
• Heavy Bleeding that requires medical treatment. Fewer than 1 in 500 procedures may require a blood transfusion or a hospital stay.

Complications of an induction can include:

• Allergic reactions to anesthetics or other medications. Reactions may produce a fever, rash, and discomfort or in rare cases, may be life-threatening and require a hospital stay.
• General anesthesia is slightly more risky than local anesthetic.
• Infections. Fewer than 1 percent of women become infected and must be treated with antibiotics. If not treated, infections may cause infertility. In rare cases, they can be life-threatening and require hospitalization.
• Injury to the cervix. Cervical injury may require stitches and increase risk for premature delivery in future pregnancies.
• Heavy bleeding that requires medical treatment. Fewer than 1 in 500 procedures requires a blood transfusion or hospital stay.
• Perforation of the uterus and/or other organs if curettage is needed to remove placenta. Perforation occurs in 3 of 1,000 procedures.

Psychological impacts associated with abortion
Studies on the psychological impacts of abortion do not provide conclusions which allow doctors and others to make statements or predictions about psychological problems associated with abortion. While many women are relieved after their abortion, some experience anger, regret, guilt, or sadness.
In a review of 250 such studies, former Surgeon General C. Everett Koop reports that factors which may make the decision about abortion more difficult for some women than others include: Strongly held personal values, feelings about abortion, pressure from others, ending an originally desired conception, a decision made late in the pregnancy, or the lack of support by a partner of family.

Effects of abortion on fertility or future pregnancies
Most studies show no impact of first trimester abortion on fertility or subsequent pregnancies. The effect of second trimester abortion (particularly if it involves multiple abortions) is undetermined.

IC Attachment C