International Journal of Medical Sciences And Clinical Research
63
https://theusajournals.com/index.php/ijmscr
VOLUME
Vol.05 Issue02 2025
PAGE NO.
63-65
10.37547/ijmscr/Volume05Issue02-11
Modern complications after abortion
Karimov A.X.
DcS, professor of the Obstetrics and gynecology in family medicine department department of Tashkent medical academy, Uzbekistan
Xayitboyeva F.A.
Master of the Obstetrics and gynecology in family medicine department department of Tashkent medical academy, Uzbekistan
Davletova D.M.
PhD, assistant of the obstetrics and gynecology department of Tashkent medical academy, Uzbekistan
Received:
16 December 2024;
Accepted:
18 January 2025;
Published:
20 February 2025
Abstract:
Around the world, abortion is a serious health problem in many countries. Every year, about 53 million
pregnancies end with induced abortion.[1] Post-abortion complications may not be as dangerous to health, such
as pain, stress, and infection, but can sometimes lead to such complex complications as atony and perforation of
the uterus. For this reason, it is important for doctors to know the main complications after abortion and to carry
out preventive measures to reduce abortions. In this article are given information of analysis of post-abortion
complications which was conducted by authors. Post-abortion complications represent a spectrum of
emergencies, from minor lacerations to life-threatening complications requiring immediate intervention. Unsafe
abortions have a much higher complication rate. These include bleeding, uterine perforation, and endometritis.
A supportive and unbiased history and physical examination are key to identifying complications of safe abortions,
as well as problems that arise after unsafe abortions.
Keywords:
Bleeding, complications, medical abortion, surgical abortion.
Introduction:
Currently, many countries have no
restrictions on abortion, but most of them have a limit
on how far into pregnancy an abortion can be
performed, typically between 6 and 24 weeks.
As of 2021, 24 countries have banned abortion entirely.
The World Health Organization (WHO) classifies
abortions as either “safe” or “unsafe.” A “safe”
abortion is performed in settings where abortion laws
do not restrict access and is performed by trained
health personnel [2]. An “unsafe” abortion is
performed by someone who lacks the necessary skills,
using unsafe materials and techniques, or in settings
where minimal medical standards are not met. Because
of the risk of complications and potential hazards
associated with abortion, especially unsafe abortion,
emergency physicians must be trained to recognize and
manage these complications.
Aim of the work was
to summarize the available
literature about complications after abortion.
METHODS
We searched PubMed for articles using the keywords
“abortion,” “complications,” and “post
-
abortion.” The
top 50 articles on the topic were reviewed. We also
reviewed the national clinical protocols of the Republic
of Uzbekistan and the Russian Federation.
RESULTS
From 2020 to 2024, the global abortion rate was
estimated at 35 per 1,000 women aged 15 to 44 years.
There are documented disparities in abortion rates,
with higher rates among women belonging to racial
minorities, with low income and low education. This
may be due to systemic challenges such as limited
access to health care, racial discrimination, poorer
living and working conditions, and higher levels of
stress. [3]
Complication rates vary depending on the type of
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International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265)
procedure, gestational age, patient comorbidities,
clinician experience, and, most importantly, whether
the abortion was performed safely or unsafely. Most
complications associated with abortion are minor, but
serious complications such as heavy bleeding,
endometritis,
and
disseminated
intravascular
coagulation (DIC) can occur. One study evaluating
54,911 abortions found an overall complication rate of
2.1%. Medical abortions had a complication rate of
5.2% (4.9% minor, 0.3% major), with complication rates
of 1.3% in the first trimester and 1.5% in the second
trimester. Vacuum aspiration abortions in early
pregnancy had a complication rate of 2.3% (1.1%
minor, 0.2% major).[4]
The overall mortality rate for safe abortions is less than
0.2%, but the mortality rate for unsafe abortions is
significantly higher. Each year, approximately 68,000
women die from complications related to unsafe
abortions. Countries with less training and access to
abortion providers have higher maternal mortality
rates. The annual maternal mortality rate related to
unsafe abortion ranges from 4.7% to 13.2%. [5] Unsafe
abortion-related deaths are most often due to septic
abortion and hemorrhage.
Vaginal bleeding is common after an abortion and is
usually comparable to or heavier than a normal
menstrual period. Patients who have had a medical
abortion typically lose more blood than those who have
had a surgical abortion and may experience symptoms
similar to those of spontaneous abortion. One study
reported that blood loss ranged from 84 to 101
milliliters (mL) in patients who had a safe medical
abortion and was 53 mL in those who had a vacuum
aspiration abortion.[7] Bleeding typically gradually
decreases over about 2 weeks after a medical abortion,
but may persist for up to 45 days in some cases.[8, 14]
Uterine perforation is a possible complication of any
intrauterine procedure and is the most common site of
upper genital tract injury. Bowel, bladder, and
surrounding vascular injury may accompany uterine
perforation. A case series of 92 uterine perforations
reported bowel or bladder injury in six cases. Overall,
uterine perforation is rare, with an incidence of 0.1% to
2.3% in safe medical abortions. The incidence of uterine
perforation is higher in unsafe abortions due to the
instruments used and the inexperience of the person
performing the procedure. Factors associated with an
increased risk of uterine perforation include surgeon
inexperience and inadequate preoperative cervical
dilation. Other factors include those that make access
to the endometrium difficult (eg, cervical stenosis,
anteflexion/retroflexion of the uterus) and those that
alter the integrity and strength of the myometrium (eg,
previous
cesarean
section,
uterine
scarring),
particularly in women undergoing second-trimester
medical abortion.[9]
Septic abortion is defined as any uterine infection
complicating spontaneous or induced abortion. It is a
potential complication of both medical and surgical
abortions and may be caused by retained products of
conception or the procedure itself (e.g., trauma,
unsterile technique). Septic abortion occurs in less than
0.4% of patients undergoing first-trimester vacuum
aspiration and safe abortions, but the rate is
significantly higher in unsafe abortions. Minor
infections occur in 24% of patients undergoing unsafe
abortions, while severe infections occur in 5.1% [10].
The most common organisms include members of the
Enterobacteriaceae family, streptococci, staphylococci,
and enterococci, which are normal endogenous flora of
the vagina and gastrointestinal tract. Other pathogens
may include Chlamydia trachomatis, Neisseria
gonorrhoeae, and Trichomonas vaginalis, which may be
associated with preexisting infections.
Toxicity from misoprostol, a prostaglandin E analogue,
is rare in safe abortions but more likely in unsafe
abortions. Toxic doses of 3 to 8 milligrams (mg) may
cause severe fever, chills, abdominal pain and
cramping, vomiting and diarrhea, agitation, altered
mental
status,
hypotension,
hypoxemia,
and
rhabdomyolysis. [11,12, 13] These signs and symptoms
usually develop rapidly after the first dose because
misoprostol is completely absorbed from the stomach
within 1.5 hours. Treatment involves removal of
remaining tablets from the stomach (eg, gastric lavage)
or vagina and supportive care, including intravenous
fluids and antiemetics. In some cases, vasopressors
may be required for patients who do not respond to
intravenous fluids. Symptoms usually resolve within 12
hours, but doses greater than 12 mg can lead to
multiple organ failure and death.
CONCLUSION
Complications following abortion represent a spectrum
of emergencies, from minor lacerations to life-
threatening
complications
requiring
immediate
intervention. Unsafe abortions have a much higher
complication rate. These include bleeding, uterine
perforation, and endometritis. A supportive and
unbiased history and physical examination are essential
to identify complications of safe abortions, as well as
problems that arise after unsafe abortions. Rapid
recognition of the specific emergency, immediate
stabilization, and possible specialist consultation can
significantly reduce morbidity and mortality.
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