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Medical and Surgical Complications of Therapeutic Abortions

From the Department of Obstetrics and Gynecology, University of California, San Francisco, San Francisco General Hospital, San Francisco, Calif and Children's Hospital and Adult Medical Center, San Francisco, Calif 94122.

Abstract

The morbidity of legal abortion seems to be directly related to the type of procedure undertaken. Early uterine evacuation has its highest morbidity in blood loss and its most significant morbidity in uterine perforation. With this procedure, morbidity is primarily related to gestational age. Intrauterine instillation of hypertonic saline produced significant morbidity from both retained products of conception and from infection. Repeat hospitalization for reattempts at abortion and for complications occurred in 6% of patients. Tubal ligation associated with early uterine evacuation produced a fourfold increase in morbidity compared with nontubal ligation. Hysterotomy or hysterectomy was associated with similar morbidity, primarily increased blood loss and a febrile postabortal course. Although maternal morbidity and mortality have decreased markedly since the Therapeutic Abortion Act of 1967 was implemented, a legal abortion is still associated with significant hazard.