What is Abortion Complications?
About a million abortions take place annually in the United States, according to the data from 2015, although the actual number may be higher as reporting of abortions in the U.S. is not compulsory. Despite being generally safe, both therapeutic abortions (medical or clinical procedures) and spontaneous miscarriages can generate various complications. Some of these complications are minor, like pain, bleeding, infection and complications from anesthesia. However, there can also be serious complications including problematic uterine contractions leading to heavy bleeding, injuries to the uterus, damage to nearby organs like the bladder or intestines, injuries to the cervix, unsuccessful abortions, septic abortions (caused by infection), and a potentially fatal blood disorder known as disseminated intravascular coagulation.
The overall rate of complications related to abortions, including those reported in emergency departments and the original abortion provider, is believed to be around 2%. It’s worth noting that roughly 40% of women who undergo an abortion end up visiting an emergency department within six weeks of their original procedure.
What Causes Abortion Complications?
There are three main ways in which complications from an abortion can be grouped.
Firstly, infection can occur if the appropriate precautions aren’t taken before the procedure. These precautions include washing hands, wearing surgical gloves, making sure the area is properly sterilized, and not using unsterilized tools. An infection can also happen if a patient has an existing infection, such as an inflammation of the cervix or uterus.
Secondly, if not all the pregnancy tissue is removed during the abortion, it can lead to a build-up of blood in the uterus. This can cause the uterus to expand too much and stop contracting, resulting in heavy bleeding. This situation can also lead to infection and, in severe cases, sepsis, which is a serious, body-wide response to an infection.
Lastly, injuries from the surgical procedure can occur, depending on the technique used. These injuries can include tears in the vagina or cervix, as well as damage to the uterus, bowel, or bladder.
Risk Factors and Frequency for Abortion Complications
The risk and seriousness of complications from an abortion depend on how far along the pregnancy is and the method used for the abortion. Research suggests that:
- The overall complication rate is about 2% for medication abortions.
- For a first-trimester aspiration abortion, the complication rate is roughly 1.3%.
- The complication rate for abortions performed in the second trimester or later is about 1.5%.
- In the United States, for every 100,000 abortions, approximately 0.6 result in death.
It’s important to note, however, that the number of deaths from septic abortions (infections) in the United States dropped quickly after abortions became legal. The risk of dying from a septic abortion also increases as a pregnancy progresses.
Signs and Symptoms of Abortion Complications
A timely and accurate diagnosis of issues relating to abortion is dependent on a thorough patient history. Health practitioners must seek information about the circumstances of the abortion, including the timing, where and by whom it was performed, and if there were any complications during or after the procedure. It’s also essential to explore the patient’s previous health and surgical history for any pre-existing conditions or surgeries that could further complicate the current situation. A detailed account of the patient’s medications, especially fertility drugs and blood-thinning medications, is crucial.
The complications a patient experiences can vary and therefore affect how they present to healthcare professionals. Complications that occur during or just after the abortion are usually managed by the provider and are not the types typically seen in emergency departments.
However, symptoms after an abortion such as pain, bleeding, or a low-grade fever are common complaints in emergency departments. In these cases, the diagnosis of leftover tissue from the pregnancy (retained products of conception) needs to be rapidly explored as a potential cause of these symptoms. Excessive bleeding may suggest a variety of issues, including a non-contracting uterus, a punctured uterus, an ectopic pregnancy, clotting disorders, or injury caused by surgical instruments. Post-abortion syndrome can cause worsening lower abdominal pain and compromised circulation without vaginal bleeding due to the buildup of blood and/or retained products of conception causing the uterus to become over-stretched and unable to contract to expel its contents.
Injury to the bowel or bladder might initially present as pain and bleeding but can rapidly develop into an infection and a severe response to infection (septic shock).
An incomplete abortion is more common early in pregnancy, and these patients may end up in the emergency department with ongoing pregnancy symptoms.
Assessment of a patient should include:
- Frequent checks of vital signs as fever may develop or changes in heart rate or blood pressure could indicate a compromised circulatory system.
- An abdominal exam to check for inflammation of the protective tissue lining the abdomen, absent bowel sounds, palpable masses, or severe tenderness.
- A pelvic exam to assess the severity of vaginal bleeding, check for visible vaginal or cervical injuries, determine if the uterus’s opening is open or closed, and note the uterus’s size and firmness as well as any uterine tenderness and/or pain in the regions where the ovaries are located.
- In case of suspected bowel injury, a rectal exam may be necessary.
- In patients with lower abdominal pain, bowel or bladder puncture should be considered.
Testing for Abortion Complications
After an abortion, different lab tests can be performed to check for potential complications. These tests include:
A complete blood count (CBC) to measure the levels of hemoglobin and hematocrit. This can help doctors determine if there’s ongoing bleeding. A complete metabolic panel checks the condition of your kidneys and liver, as well as the balance of electrolytes in your body. The Beta-human chorionic gonadotropin (Beta-hCG) test provides a baseline to track the expected decrease in hormone level or compare it to the level before the abortion.
If the patient is likely to undergo surgery, coagulation tests are necessary to measure how quickly the blood clots. In case of potential blood transfusion or Rhogam treatment, the patient’s blood type and Rh factor need to be determined. Blood cultures are important if there’s a suspicion of sepsis, a severe infection that can spread in the blood. Suspicion of a blood clotting disorder known as DIC might lead to further tests for fibrinogen, fibrin-split products, and d-dimer.
Several imaging studies can also be helpful. Abdominal X-rays are used to check for any puncture in the bowels. Pelvic ultrasound scans are performed to ensure that the pregnancy is not located outside of the womb, also known as an ectopic pregnancy. To look for fluid accumulation in the pelvic area, leftover pregnancy material, or a lump on the structures near the uterus, a computed tomography (CT) scan might be necessary.
Treatment Options for Abortion Complications
In simple terms, it’s crucial to check a patient’s blood flow status right away and set up an IV connection. If the patient appears to be losing a lot of fluid, they need to be rehydrated with IV fluids and the amount of blood loss should be estimated. Blood transfusion should be prepared for if it’s deemed necessary. The patient’s vital signs, the pace of bleeding, and overall condition need to be watched closely at all times to see if things get better or worse. If uterine atony (a loss of muscle tone in the uterus) is strongly suspected, consider treating with oxytocin in consultation with gynaecology (Ob/Gyn) specialists. If the bleeding continues, the issue could be Disseminated Intravascular Coagulation (DIC) – a condition affecting the blood’s ability to clot – and the patient should be ready for transfer to surgery or the ICU.
Apart from rehydration, patients experiencing a combination of pain, bloody discharge, and a slight fever should be given pain relief – using either non-steroidal anti-inflammatory medicine or opioids. They should also be started on a powerful range of antibiotics, given directly into the vein if possible. Most of the time, the patient will need to have blood clots or remaining tissue from conception removed. Therefore, consultation with Ob/Gyn specialists should be sought as soon as possible.
If there is suspicion of damage to the uterus, bladder, or intestines, patients need rehydration and an urgent transfer to the operating room.
If an infection-caused abortion is suspected, sepsis treatment (to fight infection) must be put in motion according to institutional guidelines. Again, broad-spectrum antibiotics should be initiated at the earliest point the diagnosis is considered, and preparations need to be made to transfer the patient to the operating room.
In a patient with stable blood flow, a pelvic ultrasound should be performed. This can help check for any tissue left behind after conception, reveal whether an abortion has failed, check for any ongoing pregnancy, or identify a pregnancy occurring outside the uterus (an ectopic pregnancy).
What else can Abortion Complications be?
- Appendicitis
- Urinary tract infection
- Kidney stone
- Pyelonephritis (infection in the kidney)
- Burst ovarian cyst
- Pelvic inflammatory disease (infection in the female reproductive system)
- Vaginitis (inflammation in the vagina)
What to expect with Abortion Complications
The overall chance of recovery after experiencing complications from an abortion is influenced by the gestational age, which is how far along the pregnancy is. The younger the gestational age, the lower the risk of complications. The greatest risk of death is due to septic abortion, often seen in cases of illegal abortions in developing countries.
According to data from the World Health Organization, approximately 70,000 women die each year globally due to complications stemming from illegal or unsafe abortions. The United States reported only 10 such deaths in 2010, but this number could be higher due to possible under-reporting.
Possible Complications When Diagnosed with Abortion Complications
Some notable risks associated with abortions include:
- Bleeding profusely (Hemorrhage)
- Widespread infection (Sepsis)
- Inflammation of the tissue lining the inner wall of the abdomen (Peritonitis)
- Blood clot in a deep vein, usually in the leg (Deep vein thrombosis)
- Potential death
Nevertheless, it’s important to note that several studies have shown that medically supervised abortions are significantly safer than childbirth.
Preventing Abortion Complications
After an abortion, it’s important for patients to understand that they need to see a doctor right away if they notice increasing bleeding, pain, or any signs of infection. They should also avoid using tampons or engaging in sexual activities for two weeks following the procedure. Patients should know that it’s normal to feel guilt and sadness after an abortion, and that there is counseling available to support them. The healthcare provider should also discuss the importance of using effective birth control methods to prevent unintended pregnancies. If the abortion was due to an infection, it’s critical for the patient to continue taking their antibiotics as prescribed.
