Complications of first-trimester abortion: a report of 170,000 cases

Article Abstract:

Planned Parenthood of New York City is a women's health organization committed to providing low-cost abortion services within the first 12 weeks of pregnancy. Although the safety of early abortion has been well-established by smaller studies, this report differs in that the study population was a large group of women having an early abortion during the course of 16 years. The experience with 170,000 abortions performed in three New York Planned Parenthood clinics from 1971-1987 is reported. Local anesthesia was used in 70 percent of the pregnancy terminations and the remainder received general anesthesia using the anesthetic agent methohexital. None of the women received any medication before the procedure, and antibiotics were not given routinely after the procedure. Patients considered high-risk and not good candidates for termination in the clinic were referred to a hospital for the procedure. None of the women having first-trimester terminations died from the procedure. Complications such as perforation of the uterus, pregnancies implanting outside of the uterus (ectopic pregnancies), hemorrhage, infection or incomplete abortion were suspected in 121 women (0.71 per 1,000 procedures), who were subsequently hospitalized. None of the women required removal of any organs, including the uterus. Minor complications such as infection, subsequent resuctioning of the contents of the uterus, narrowing of the opening to the cervix (cervical stenosis), tears of the cervix, or underestimation of fetal age were experienced by an additional 1,438 women (8.46 per 1,000 procedures). The overall complication rate was 9.05 complications per 1,000 pregnancy terminations. There was no difference in the complication rate between general and local anesthesia patient groups. This study confirms that pregnancy terminations performed on healthy women meeting strict criteria who are pregnant less than 14 weeks from the last menstrual period is an extremely safe procedure to perform in a free-standing abortion clinic. (Consumer Summary produced by Reliance Medical Information, Inc.)

Services, Planned Parenthood Federation of America, Family planning services

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Uterine perforation during second-trimester abortion by cervical dilation and instrumental extraction: a review of 15 cases

Article Abstract:

Elective abortions can be performed using the dilatation and extraction (D&E) technique, which involves dilation of the cervix and vacuum extraction of the uterine contents. Abortions performed during the first three months of pregnancy use instruments which have smaller diameters. In these cases, perforation of the uterus is generally harmless and rarely causes trauma to nearby abdominal structures. However, second trimester D&E abortions, which are the safest of all available methods, require larger instruments. Perforation of the uterus can have serious consequences and can potentially damage nearby abdominal structures. The characteristics of uterine perforation during an elective second trimester D&E were evaluated by reviewing the records of 15 women. The most common symptom following uterine perforation was pain, rather than excessive bleeding. Laparoscopy, the use of a small tube affixed with a magnifying device to examine internal structures, did not prove helpful as a first-line diagnostic procedure. All the women eventually needed a laparotomy, exploratory abdominal surgery to examine pelvic structures. The most common reason for complications during abortion is the incorrect estimation of the duration of pregnancy, and in six cases the pregnancies were two weeks further along than originally estimated. Inadequate dilatation of the cervical opening prior to abortion is another complicating factor. The use of ultrasound to visualize the products of conception can help to guide instruments and avoid uterine perforation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Obstetrical extraction

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Postabortal hemorrhage due to placenta increta: a case report

Article Abstract:

Placenta accreta is a complication of pregnancy caused by the abnormal attachment of the placenta to the wall of the uterus. Placenta increta occurs when the placenta attaches deep within the myometrium (muscle layer). The abnormally attached placenta is unable to separate from the wall of the uterus during delivery and bleeding during or immediately after delivery can be severe. Placenta increta is rarely diagnosed before the 20th week of pregnancy. Only eight cases have been reported during the first three months of pregnancy. A 34-year-old woman who developed abnormal vaginal bleeding was referred for pelvic ultrasound. An irregularly shaped gestational sac was discovered within her uterus. A missed abortion was diagnosed and the products of conception were removed by suction. Severe bleeding followed and a laparoscopy (the use of a small tube inserted into the abdomen to visualize internal structures) was performed to rule out uterine perforation. No tears were visible and a repeat curettage was performed. This precipitated profuse bleeding again and a total abdominal hysterectomy was warranted. Biopsy revealed chorionic villi deep within the myometrium. Placenta accreta should be suspected when abnormal bleeding is followed by first trimester abortion. A history of repeated cesarean section is a major risk factor for placenta accreta. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Placenta accreta

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