Last Updated: 26 January 2016

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Physical Risks of Abortion

Medical Abortion: Physical Risks

Medical Abortion: Short-Term Physical Risks

Medical Abortion: Long-Term Physical Risks 

Surgical Abortion: Physical Risks

Surgical Abortion: Short-Term Physical Risks

Surgical Abortion: Long Term Physical Risks 

 

 

Physical Risks of Abortion

 

If you are considering an abortion, the physical risks vary depending on your personal circumstances.  However based on various studies conducted in countries where abortion is legal, the average risk you may experience immediate medical complications is:

  • For a surgical abortion, approximately 5-6%, i.e. about 1 in 20 women experience complications.
  • For a medical abortion, approximately 20-25%, i.e. up to a quarter of women experience complications.

According to various studies, the risk of immediate medical complications after a surgical abortion may between 3.4% and 11%, depending on where the abortion takes place and other risk factors.  

It is undisputed that a medical abortion is significantly riskier than a surgical abortion.  Studies have reported that the risk of complications after a medical abortion may be 4-5 times higher than for a surgical abortion.1

 

Factors that Increase the Risk of Abortion 

You are significantly more likely to have complications following an abortion if you:

  • Are younger than 20 years old;
  • Live in a rural area;
  • Have a medical abortion rather than a surgical abortion;
  • Have had previous pregnancies;
  • Have had one or more previous abortions
  • Are beyond 8 weeks gestational age in the pregnancy.

The risks of complications with an abortion greatly increases with each gestational week of your pregnancy.  One study found the risk of death increased by 38% for each additional week.2  Women who have an abortion in the second trimester are significantly more likely to die of abortion-related causes than women who have have an abortion at or before 8 weeks gestation.2

Evidence shows that for abortions performed up to 9 weeks gestation (63 days) the short-term risk of complications with a medical abortion (especially bleeding) is significantly higher than with a surgical abortion.  

A study of all women in Finland who had an abortion from 2000-2006, found that the number of complications with medical abortions is four times higher than with surgical abortions.3  A review of nearly 7,000 abortions in Australia in 2009 & 2010 found that 5.7% of women who used the abortion pill in the first trimester needed to be admitted for treatment of complications, in comparison ot 0.4% of women admitted who had undergone a surgical abortion.4  So approximately 5 times more women need to be treated in Australia for immediate complications after medical abortion than after surgical abortion.

An earlier 1999 U.S. study revealed that the rate of complications requiring suction curettage (for incomplete abortion, ongoing pregnancy or excessive bleeding) was 18.3% after a medical abortion and 4.7% after a surgical abortion.

 

Medical Abortion: Physical Risks

Physical risks are involved with medical abortions when the Abortion Pill, RU486 (Mifepristone, brand name 'Mifeprex') and/or Misoprostol (a synthetic prostaglandin, brand name 'Cytotec') is used or other types of prostaglandins which induce labour (cause the womb to contract and dispel the baby).

The short term physical risks are Excessive Bleeding, Hemorrhage, Fever, Abdominal Pain and Cramping, Incomplete Abortion (Retained Tissue), Infection, Pulmonary or Amniotic Fluid Embolism, Missed Ectopic Pregnancy and Death.

The long term physical risks are increased risk of Infertility, Subsequent Preterm Birth (PTB), Ectopic Pregnancy, Placenta Previa and Breast Cancer.

Find out the mental risks of abortion on our page Psychological Risks.

 

Medical Abortion: Short-Term Physical Risks (up to six weeks after procedure)

 

Use of Abortion Pill RU486 (Mifepristone) and/or Misoprostol May Cause:-

Some bleeding after taking the Abortion Pill RU486 (Mifeprex) is normal (bleeding and/or spotting for 9-16 days is expected).  However, in about 1 out of 100 women, bleeding can be so heavy as a result of the abortion pill that it requires a surgical procedure to stop it.5   One study found 1 in every 200 women experienced haemorrhaging (loss of over 1000mL blood), after a first trimester medical abortion with some requiring a blood transfusion.4

Misoprostol (Cytotec is a brand commonly used) is a synthetic (man-made) prostaglandin used to induce contractions and is frequently given after the abortion pill in a medical abortion (or sometimes used on it's own).  The uterus (womb) is sometimes so hyperstimulated by the misoprostol that it ruptures (tears), causing life-threatening bleeding to the woman.   

The warning label of Cytotec clearly states "UTERINE RUPTURE HAS BEEN REPORTED WHEN CYTOTEC WAS ADMINISTERED IN PREGNANT WOMEN TO INDUCE LABOR OR TO INDUCE ABORTION BEYOND THE EIGHTH WEEK OF PREGNANCY" (Uppercase on label).  Label then states: This can result in "severe bleeding, hysterectomy (removal of uterus) and/or maternal or fetal death.. Pelvic pain, retained placenta, severe genital bleeding, shock, fetal bradycardia and fetal and maternal death have been reported".6

 

  • Fever, Abdominal Pain and Cramping

 Women who choose an early medical abortion are 'expected to manage pain, bleeding and nausea at home with the support of another adult'.4

 

Excessive bleeding may be a sign of an incomplete abortion.  For an incomplete abortion, a surgical abortion is needed for treatment.  As high at 5.6% of women who have a medical abortion within the first 9 weeks gestation, will require a surgical abortion to remove parts of the baby or placenta that remain.4  With each further week of pregnancy, the rates of women requiring a surgical abortion due to an incomplete medical abortion increases.

The risk of sepsis is a rare immedicate complication of a medical abortion.

  

RU486 will not work if the pregnancy is an ectopic pregnancy.  An ectopic pregnancy is when the embryo lodges outside the uterus, usually in the fallopian tube.  If an ectopic pregnancy is not diagnosed early, the tube may burst, causing internal bleeding and is life-threatening to the woman.

 

  • Death

Death of the woman as a result of legal medical abortion is rare when abortions carried out according to medical protocols - e.g. in the US, according to the FDA  (Food and Drugs Authority) plan, which says mifepristone and misoprostone must taken orally before 9 weeks gestation and subscribed by qualified medical practitioners.  According to numbers of reported deaths to the US FDA, the risk of death is about 1 in 100,000 and is usually due to Sepsis (infection).7  

The violent contractions that misoprostol can provoke may also result in stroke or death due to amniotic fluid emboli but this risk is extremely low.

 

Medical Abortion: Long-Term Physical Risks (further than 6 weeks after procedure)

 

  • Subsequent Preterm Birth

It is unknown at this time whether medical abortions affect the risk of a future preterm birth in a subsequent pregnancy.  Once well-designed study of 18,323 women found that there was no significantly increased risk of preterm birth with medical abortions compared to no abortions. however for women who had a medical abortion before 7 weeks gestation and who needed a suction curettage to complete the abortion, the risk of a preterm birth (birth prior to 37 weeks), increased by 69%.   Of the women studied who had a medical abortion, 20% needed suction curettage after the medical abortion.

 

 

Surgical Abortion: Physical Risks

Regarding surgical abortions, 1998 study at a family planning center in Paris found a complication rate of 3.4%, a 2011 study in Ontario, Canada found an average complication rate of 4.5%, a 2002 Denmark study found a complication rate of 5%, a 1993 NZ study found a complication rate of 5.8% and in 2000 the British Royal College of Ob/Gyn's gave an immediate complication rate of over 11%.  So based on the available research, the average complication rate for a surgical abortion is between 5 - 6%.  

This means if you are considering a legal surgical abortion, you have approximately a 1 in 20 risk of immediate complications, although this figure may be higher or lower depending on where the abortion takes place and whether there are other considerations that would make an abortion riskier in your situation.

Surgical abortion procedures include 'Manual Aspiration', 'Vacuum Aspiration''Suction Curettage''Sharp Curettage''Dilation and Curettage (D&C)''Dilation and Evacuation (D&E)''Dilation and Extraction' (IDX)'Induced Abortion''Hysterotomy''Hysterectomy' and Cord Occlusion (Blocking) Techniques.

The short term physical risks include Excessive Bleeding, Hemorrhage, Infection, Incomplete Abortion (Retained Tissue), Damage to Organs including Utertine Perforation and Cervical Laceration, , Death

The long term physical risks are increased risk of Infertility, Subsequent Preterm Birth (PTB), Ectopic Pregnancy, Placenta Previa and Breast Cancer.

Find out the mental risks of abortion on our page Psychological Risks.

 

Surgical Abortion: Short-Term Physical Risks (up to 6 weeks after procedure)

 

  • Excessive Bleeding, Hemorrhaging
  • Fever, Abdominal Pain and Cramping
  • Incomplete Abortion (Retained Tissue)
  • Infection
  • Damage to Organs
  • Death

 The risk of death from a legal surgical abortion procedure (carried out by a qualified medical practitioner) is extremely low according to available research - approximately 1/1,000,000.

 

Surgical Abortion: Long Term Physical Risks (further than 6 weeks after procedure)

 

  • Subsequent Preterm Birth

 

 

  • Placenta Previa

Placenta Previa is when the placenta partially or totally cover the woman's cervix and this can cause severe and very dangerous bleeding before or during delivery.   The woman is at risk of death from hemorrhaging and baby may have to be delivered early by C-section.

Induced abortion increases the risk of a woman developing Placenta Previa in future pregnancies.  Also the relative risk of a woman who has had Dilation and Curettage (D & C) abortion developing Placenta Previa is 1.9 higher than a woman who has not had an abortion.

If a woman gets an infection as a result of an abortion, she is at even greater risk of Placenta Previa.  Her risk is 3.6 compared with a woman who has not had an abortion.

 

 

Footnotes:

 

1  Shadigan, Elizabeth. Reviewing the Medical Evidence: Short and Long-Term Consequences of Induced Abortion', testimony before the South Dakota Task Force to Study Abortion, South Dakota, September 21, 2005.  This testimony can be found at http://www.abortionbreastcancer.com/PHYSICAL_EFFECTS_OF_ABORTION.pdf  Retrieved 2 August 2014.

2  Bartlett LA, Berg C, Shulman HB, et al. Risk factors for legal induced abortion-related mortality in the United States. Obstet. Gynecol. 103: 729-737. 2004.  http://www.ncbi.nlm.nih.gov/pubmed/15051566  Retrieved 3 August 2014

3  M. Niinimaki et al. Immediate Complications after Medical compared with Surgical Termination of Pregnancy, Obstet. Gynecol. 114: 795 (Oct 2009) http://www.ncbi.nlm.nih.gov/pubmed/19888037  Retrieved 3 August 2014

4  E. Mulligan & H. Messenger. Mifepristone in South Australia: The First 1342 Tablets. Australian Family Physician. 4095): 342-45. (May 2011).  http://www.frcblog.com/wp-content/uploads/2011/05/Australian-AERs_RU486_201105mulligan.pdf  Retrieved 3 August 2014.

5  See Medication Guide: Mifeprex (mifepristone).  http://www.fda.gov/downloads/Drugs/DrugSafety/UCM088643.pdf Approved by US Food and Drug Administration.  Retrieved 31 July 2014.

6  Label of 'Cytotec' misoprostol tablets as at : http://labeling.pfizer.com/ShowLabeling.aspx?id=559  Retrieved 31 July 2014.

7 Estimated death rate from mifepristone abortion is 1 in 100,000 (mostly due to sepsis infection): http://www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformationforpatientsandproviders/ucm111323.htm

 

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