Complications related to induced abortion: a combined retrospective and longitudinal follow-up study

Abstract

BackgroundInduced abortion is one of the most common gynecological procedures in Sweden, but there is still little knowledge about the adverse effects. The aims of this study are to provide an overview of complications of medical and surgical abortions and to evaluate the impact of bacterial screening to prevent postabortal infections.MethodsAll women who underwent induced abortion at Skaraborg Hospital between 2008 and 2015 are included in the study. Bacterial screening for chlamydia, gonorrhea, mycoplasma, and bacterial vaginosis was performed prior to the abortions. Abortion complications, categorized as bleeding, infection, or incomplete abortion were assessed in women who came in contact with the gynecological clinic within 30 days after the procedure.ResultsA total of 4945 induced abortions were performed during the study period. Nearly all, 4945 (99.7%) were eligible for inclusion in the study. Medical abortions < 12 weeks were the most common procedure (74.7%), followed by surgical abortions (17.5%), and medical abortion > 12 weeks (7.8%). Complications were registered in 333 (6.7%) of all abortions. Among medical abortions < 12 weeks, the complication frequency increased significantly, from 4.2% in 2008 to 8.2% in 2015 (RR 1.49, 95% 1.04–2.15). An incomplete abortion was the most common complication related to medical abortions < 12 weeks. Of all women who tested positive for one or several bacteria at the screening and therefore received antibiotics, 1.4% developed a postabortal infection. Among those who tested negative at the screening, 1.7% developed infectious complications.ConclusionsThe share of complications related to medical abortions < 12 weeks increased significantly during 2008–2015 without any evident cause. Women who tested positive for one or several bacteria upon screening and received antibiotics experienced almost an equal proportion of postabortal infections compared to women who tested negative upon screening. The screening process seems to fulfill its purpose of reducing the risk of infectious complications.

The level and deriving factors of repeat-induced abortion in Ethiopia: A systematic review and meta-analysis

“…A systematic review conducted about induced abortion indicated that poor contraceptive use, domestic abuse, and other adverse life events were found to be the predictors of repeat-induced abortion [ 15 ]. Individuals with repeat-induced abortion are more likely to experience long term obstetric complications in subsequent pregnancies in addition to short term complications [ 16 ]. Women who undergo repeat-induced abortion are also more likely to experience a feeling of shame and stigma compared with those who visited health facilities for the first time.…”

Human Uterine Decidual NK Cells in Women with a History of Early Pregnancy Enhance Angiogenesis and Trophoblast Invasion

“…Although IAs are generally safe and effective, the side effects and influence on subsequent pregnancies should not be ignored. According to previous studies, repeated IAs may cause uterine adhesion, placenta previa, and pelvic inflammation, which impact subsequent pregnancies [8]. However, studies have shown a lower risk of PE associated with IAs in primiparous women [9][10][11][12][13].…”

Role of Vaginal Microbiota Dysbiosis in Gynecological Diseases and the Potential Interventions

“…Induced abortion is a fairly common gynecological operation worldwide, and whether it is drug-induced or surgery-induced, it can cause a great damage to the female reproductive tract and predispose to serious complications such as incomplete abortion, heavy bleeding, infection, scarring of endometrium, adhesions of the uterine cavity and cervix, and endometriosis. Among these, upper genital tract infection is the most concerned and common clinical problem, which can further cause endometritis, salpingitis, and infertility (Mary and Mahmood, 2010;Carlsson et al, 2018).…”

“…In this regard, World Health Organization (WHO) recommended the use of antibiotic prophylaxis to prevent the abortion-induced infection, and a meta-analysis of randomized clinical studies showed that perioperative antibiotics (metronidazole, nitroimidazoles, etc.) could effectively reduce the risk of postabortal infection by 50% (Sawaya et al, 1996;Carlsson et al, 2018). However, if the homeostasis of the uterus is not fully restored and is still conducive to microbial disorders, antibiotics cannot protect the women from being reinfected (Low et al, 2012).…”