Complications

• Continuing pregnancy:
  • seen in 0.2% performed at a gestation of 12 weeks or less
  • high risk of failure after a procedure observed in
    • multiparous women
    • six weeks’ gestation or less
    • inexperienced surgeons performing abortions
    • women with uterine abnormalities
  • in early medical abortion with mifepristone-misoprostol regimens, a continuing pregnancy rate of 0.5%-0.7% has been reported
  • more common with the use of oral or lower doses of misoprostol
  • repeated dose of misoprostol is effective in less than 40% of cases, hence vacuum aspiration is recommended
• Incomplete abortion:
  • results in prolonged bleeding and uterine cramping
  • vacuum aspiration or misoprostol can be used
  • frequency of reaspiration after first trimester surgical abortion is 0.3-2% while in second trimester it is 0.4–3%
• Haemorrhage that often requires transfusion:
  • after early medical abortion blood transfusion is necessary in 0.1% while in later medical abortions the figure slightly rises to 0.7%
• Cervical damage:
  • cervical incompetence and subsequent middle trimester abortion
• Uterine trauma, which occurs in 0.1–0.4% of surgical abortions.
• Failed operation.
• Sepsis:
  • antibiotic prophylaxis is beneficial in surgical abortion but its use in medical abortion is less clear (1)
• Sensitization of a Rh-negative woman.
• Acute renal failure, possibly secondary to septic shock and hypovolaemia.

Reference:

1. Lohr PA et al. Abortion.  BMJ 2014;348:f7553