Short-term Health Risks

Acute Hematometra (postabortal syndrome)

Acute hematometra occurs when the uterus fills with blood and blood clots, generally as a result of retained tissue. Symptoms usually occur within an hour of the abortion, and include increasing lower abdominal cramping and an enlarged, tender uterus. If fetal parts or placental tissue remains in the uterus, it will not contract effectively. Acute bleeding into the uterus results. The woman will have to undergo another procedure to clean out the uterus completely, and she will need drugs to help her uterus contract.(iii,iv,v)

Retained products of conception (retained fetal and placental tissue)

Retained tissue is the result of an incomplete abortion. This may cause excessive and prolonged hemorrhage. A life-threatening later complication is septic infection of the uterine lining.(vi,vii,viii)

Endometritis (infection of the lining of the uterus)

Endometritis is an infection of the uterine lining. It is usually associated with retained tissue. Endometritis can lead to toxic shock syndrome, which can be fatal. Fatal toxic shock syndrome has been associated with the bacterium clostridium sordellii following medical abortion. A Canadian woman died of the same condition in 2001 during clinical trials involving medical abortion with the drugs mifepristone (RU 486) and misoprostol. The trials were halted, and mifepristone is not approved for medical abortion in Canada.(ix,x,xi,xii)

Uterine perforation and lacerations

Uterine perforation is most common with surgical abortion. According to one abortionist, "Uterine perforation is an inevitable occurrence if one does enough abortions or dilatation and curettage procedures of any sort."(xiii) Perforation can occur with the use of rigid dilating rods, sharp curettes, suction catheters, forceps, or fetal bone fragments. When the uterine blood vessels are damaged, life-threatening hemorrhage occurs. If the abortion instruments enter the abdominal cavity, injury can result to many organs surrounding the uterus. Suction abortion can cause a section of the bowel to be sucked into the otherwise sterile uterus. Damage to the bowel or other pelvic organs can cause immediate life-threatening hemorrhage and septic infection. Hysterectomy, or removal of the uterus, may be necessary to save the woman’s life, leaving her permanently infertile. In some cases, surgery to repair the bowel or other organs may be necessary.(xiv,xv)

Hemorrhage

Hemorrhage, or heavy bleeding, is one of the most common after-effects of abortion. Heavy, prolonged bleeding is associated with medical abortion and may be the result of incomplete abortion, or failure of the uterus to contract following the abortion.(xvi,xvii,xviii,xix)

Hemorrhage associated with surgical abortion is often caused by injury to the cervix or uterus, retained tissue, or failure of the uterus to contract.(xx,xxi)

In later abortions, and saline abortions, the risk of a life-threatening complication called disseminated intravascular coagulation (DIC), along with hemorrhage, is increased.(xxii,xxiii,xiv)

Disseminated Intravascular Coagulation (DIC)

DIC results in widespread blood clotting in the tiny peripheral blood vessels throughout the body, causing tissue starvation and eventual tissue death. As the clotting factors are depleted, massive hemorrhage occurs throughout the body.(xxv)

Cervical lacerations and injury

Cervical injury can occur as a result of vigorous and forceful opening of the cervix with rigid dilators and laminaria preparations. Clamps and the surgical instruments used in the abortion, as well as fetal bone fragments can also injure the cervix.(xxvi) Low cervical perforations may injure the uterine artery and cause severe hemorrhage and death.(xxvii)

Cervical injury may also lead to incompetent cervix. An incompetent cervix is abnormally prone to dilating before term delivery, and is a risk factor for pre-term birth. The risk for pre-term birth in subsequent pregnancies increases with more abortions.(xxviii)

Gastro-intestinal disturbances (nausea, vomiting, diarrhea)

Nausea, vomiting and diarrhea may follow abortion, especially with medical abortions involving prostaglandins or abortions involving the use of oxytocin to help the uterus to contract.(xxix,xxx)

Convulsion

Convulsion can be a true epileptic seizure, a reaction to anesthetics, or a hysterical manifestation.(xxxi)

Saline poisoning (salt poisoning, hypernatremia)

Hypernatremia can occur in saline abortion, with the injection of the salt solution into the mother’s system instead of the fetus or amniotic sac. Hypernatremia develops quickly, and in high levels is toxic to the brain.(xxxii,xxxiii) In fact, saline abortion has fallen out of favour because of this risk.(xxxiv)

Uterine Rupture

Uterine rupture can occur with the use of oxytocin, or misoprostol when used to stimulate uterine contractions. Surgery, and sometimes removal of the uterus is needed to control bleeding.(xxxv,xxxvi)

Embolism

An embolism is the sudden blocking of an artery by a clot of foreign material, such as a blood clot, fat globule, air bubble, or piece of tissue. Unless the blockage is quickly relieved, tissues past the blockage will die.(xxxvii) Abortion can result in amniotic fluid and air embolism.(xxxviii,xxxix)

Anesthetic reactions

Both local and general anesthesia in abortion have resulted in death.(xl,xli) General anesthetic is used less often than local anesthetic,(xlii) but both carry risks.

Pelvic Inflammatory Disease (PID)

The development of pelvic infection following abortion is one of the most commonly-occuring side effects. PID carries long-term risks of chronic pelvic pain, dyspareunia (pain during sexual intercourse), reduced fertility and ectopic pregnancy.(xliii,xliv)

Mortality

A small but consistent number of maternal deaths result from abortion, although the numbers likely remain under-reported. Most of these deaths are caused by hemorrhage, infection, embolism, or cardiomyopathy. Complications stemming from general anesthesia are also a factor in maternal mortality following abortion.(xlv)

The maternal death rate in the 12 months following an abortion is four times greater than the rate of death among women following completed pregnancies, according to a Finland study from 1997.(xlvi)

First published on AbortionInCanada.ca. Reprinted with permission.