RECENT ELECTIVE ABORTION AUGUST 10, 2016 by Dr. Courtney Cassella from emdocs.net reviews the emergency department care of patients with complications from recent medical or surgical abortions.
The following are some excerpts from the post:
Timing of Complications with Induced Abortion11
- Immediate (within 24 hours): Bleeding, pain
- Uterine perforation
- Cervical lacerations
- Delayed (between 24 hours and 4 weeks): Bleeding or Discharge
- Retained products of conception
- Endometritis
- Late complications (> 4 weeks): Amenorrhea
Summary
- Immediate (<24 hours) complications of induced abortion include hemorrhage and pain, commonly caused by cervical laceration and uterine perforation.
- Delayed (24 hours – 4 weeks) complications include retained products of conception and infection.
- Key historical features to evaluate induced abortion complication risk are: prior cervical surgery, prior Caesarean section, increased gestational age, and parity.
- Consider early OB-GYN consult in any post-abortion patient
- Risk stratify patients for ectopic pregnancy
- Review pre-procedure imaging for documentation of intrauterine pregnancy
- Ultrasound is a key imaging modality for suspected delayed complications of induced abortion.
- If you suspect septic abortion, cover for normal vaginal flora and sexually transmitted diseases
Resources (These references are all from the above article and the numbering is from the article – Go there to see the complete list.):
- 1. Upadhyay UD, Desai S, Zlidar V, Weitz TA, Grossman D, Anderson P, et al. Incidence of emergency department visits and complications after abortion. Obstetrics and gynecology. 2015;125(1):175-183. [PubMed Abstract]
- 8. Cleland K, Creinin MD, Nucatola D, Nshom M, Trussell J. Significant adverse events and outcomes after medical abortion. Obstetrics and gynecology. 2013;121(1):166-171. [PubMed Abstract] [Full Text HTML] [Full Text PDF]
- 9. Ireland LD, Gatter M, Chen AY. Medical Compared With Surgical Abortion for Effective Pregnancy Termination in the First Trimester. Obstetrics and gynecology. 2015;126(1):22-28. [PubMed Abstract]
- 10. Zane S, Creanga AA, Berg CJ, Pazol K, Suchdev DB, Jamieson DJ, et al. Abortion-Related Mortality in the United States: 1998-2010. Obstetrics and gynecology. 2015;126(2):258-265. [PubMed Abstract] [Full Text HTML] [Full Text PDF]
- 13. Kerns J, Steinauer J. Management of postabortion hemorrhage: release date November 2012 SFP Guideline #20131. Contraception. 2013;87(3):331-342. [PubMed Abstract] [Full Text HTML] [Full Text PDF]
- 14. White K, Carroll E, Grossman D. Complications from first-trimester aspiration abortion: a systematic review of the literature. Contraception. 2015;92(5):422-438. [PubMed Abstract]
- 23. Eschenbach DA. Treating spontaneous and induced septic abortions. Obstetrics and gynecology. 2015;125(5):1042-1048. [PubMed Abstract]
