Complications after Second Trimester Surgical and Medical Abortion

Uterine perforation as a complication of surgical abortion causing small bowel obstruction: a review

“…Major complications requiring hospitalization have ten times less incidence (0.071%) and include incomplete abortion, sepsis, uterine perforation, vaginal bleeding, inability to complete abortion, and combined (heterotopic) pregnancy. Uterine perforation during abortion is rare, with incidence of 0.05 -0.4% [12][13][14][15][16][17] but up to 3.6% in undeveloped countries [18].…”

“…The distribution of this complication through the trimesters is contrary to the fact that second trimester abortion has a higher rate of all complications than abortions performed in the first trimester [13,15,31]. This is due to: (1) higher incidence of (legal or illegal) surgical abortions during the first trimester and (2) thickening of the uterus as pregnancy advances lowering the possibility of instrumental perforation.…”

“…Other factors were advanced maternal age, greater parity, retroverted uterus, history of prior abortion or cesarean section, history of previous cone biopsy, failure to use ultrasound, and underestimation of the duration of pregnancy [13][14][15]33]. In a study by Amarin and Badria uterine perforations were mostly located at the uterine fundus, presumably caused by the introduction of cervical dilators [34].…”

“…In a study by Amarin and Badria uterine perforations were mostly located at the uterine fundus, presumably caused by the introduction of cervical dilators [34]. Hence, difficulty during cervical dilatation also has been associated with a higher perforation rate, and some authors recommend prostaglandin use to aid in dilatation of the cervix [13,15]. Additionally, prostaglandins have the benefit of contracting the uterus, which may help decrease the perforation rate [14].…”

A Critical Appraisal of Laws on Second Trimester Abortion

“…Complication rates with skilled provision of currently approved second trimester abortion methods (mifepristone-misoprostol and dilatation and evacuation (D&E)) are also very low. 12 Proportion of safe second trimester abortions to total abortions There will always be women who need abortions after 13 weeks of pregnancy, but the numbers diminish greatly by 20 weeks, becoming rare after 24 weeks. It is not the law that makes this happen, but women themselves.…”