Incidence of Emergency Department Visits and Complications After Abortion

Abstract

OBJECTIVE: To conduct a retrospective observational cohort study to estimate the abortion complication rate, including those diagnosed or treated at emergency departments (EDs). METHODS:Using 2009-2010 abortion data among women covered by the fee-for-service California Medicaid program and all subsequent health care for 6 weeks after having an abortion, we analyzed reasons for ED visits and estimated the abortion-related complication rate and the adjusted relative risk. Complications were defined as receiving an abortion-related diagnosis or treatment at any source of care within 6 weeks after an abortion. Major complications were defined as requiring hospital admission, surgery, or blood transfusion. RESULTS:A total of 54,911 abortions among 50,273 feefor-service Medi-Cal beneficiaries were identified. Among all abortions, 1 of 16 (6.4%, n53,531) was followed by an ED visit within 6 weeks but only 1 of 115 (0.87%, n5478) resulted in an ED visit for an abortionrelated complication. Approximately 1 of 5,491 (0.03%, n515) involved ambulance transfers to EDs on the day of the abortion. The major complication rate was 0.23% (n5126, 1/436): 0.31% (n535) for medication abortion, 0.16% (n557) for first-trimester aspiration abortion, and 0.41% (n534) for second-trimester or later procedures. The total abortion-related complication rate including all sources of care including EDs and the original abortion facility was 2.1% (n51,156): 5.2% (n5588) for medication abortion, 1.3% (n5438) for first-trimester aspiration abortion, and 1.5% (n5130) for second-trimester or later procedures.CONCLUSION: Abortion complication rates are comparable to previously published rates even when ED visits are included and there is no loss to follow-up. 1 accurate estimates of abortion complications are paramount to assess and improve quality of care and determine how public policies can most effectively safeguard women's health. Although national abortion-related mortality data exist for the United States, 2 no surveillance system captures abortion-related morbidity. Studies find varying complication rates 3-7 depending on the procedure, weeks of gestation, length of follow-up, and protocols used to detect complications. Furthermore, complication rates are underestimated by low followup rates. 5,[7][8][9] Published complication rates are considered incomplete because they usually do not include those diagnosed at sites other than the original source of care. 10From the Advancing New Standards in Reproductive Health

Cervical Preparation Before Dilation and Evacuation Using Adjunctive Misoprostol or Mifepristone Compared With Overnight Osmotic Dilators Alone

“…Collectively more women in the dilators-alone arm had uterine reaspiration, a cervical laceration requiring sutures, or hemorrhage requiring intervention beyond uterotonics than women in the misoprostol or mifepristone arms; although warranting further investigation, these differences were not statistically significant. Although the complication rate of 10% in the dilators-alone arm appears higher than rates reported in large retrospective studies of secondtrimester abortion, 3 it is comparable to rates reported in other prospective trials of cervical preparation before dilation and evacuation at 20-23 6/7 weeks of gestation. 13 We anticipated a priori that we would have inadequate power to measure complications as our primary outcome, which is why we chose the primary outcome of operative time.…”

Complications from first-trimester aspiration abortion: a systematic review of the literature

“…Of the 12 ASC and hospital-based studies that reported on this intervention, only two reported transfusion was necessary, and each study cited only one case out of 6,093 total abortions [45,56]. A transfusion was necessary in <0.1% of US office-and hospital-based abortions in the third phase of the US-based Joint Program for the Study of Abortion (JPSA-III), [71] and Upadhyay et al's [73] study using Medi-Cal claims, which included a total of 88,755 first-trimester procedures.…”

“…Niinimäki et al [74] combined ICD-10 codes for surgical interventions with those for cervical lacerations and any uterine perforation in Finnish registry data. The 0.6% of abortions requiring abdominal procedures in that study is likely an overestimate, since another claims-based study reported <0.1% of first-trimester aspiration abortions had a CPT code for an abdominal surgical procedure [73].…”

Unintended pregnancy: a framework for prevention and options for midlife women in the US

“…Overall, abortion is very safe; a first-trimester abortion is one of the safest medical procedures and carries minimal risk-less than 0.05%-of major complications that might need hospital care [53][54][55]. Mortality is extremely rare when abortion is performed by qualified, competent licensed healthcare providers and occurs early in pregnancy [56].…”