Abortion, Induced Health Article

Diagnosis/Preparation

The doctor must know accurately the stage of a woman's pregnancy before an abortion is performed. The doctor will ask the woman questions about her menstrual cycle and also do a physical examination to confirm the stage of pregnancy. This may be done at an office visit before the abortion or on the day of the abortion.

Pre-abortion counseling is important in helping a woman resolve any questions she may have about having the procedure. Some states require a waiting period (most often of 24 hours) following counseling before the abortion may be obtained. Most states require parental consent or notification if the patient is under the age of 18.

Aftercare

Regardless of the method used to perform the abortion, a woman will be observed for a period of time to make sure her blood pressure is stable and that bleeding is controlled. The doctor may prescribe antibiotics to reduce the chance of infection. Women who are Rh negative (lacking genetically determined antigens in their red blood cells that produce immune responses) should be given an injection of human Rh immune globulin (RhoGAM) after the procedure unless the father of the fetus is also Rh negative. This prevents blood incompatibility complications in future pregnancies.

Bleeding will continue for about five days in a surgical abortion and longer in a medical abortion. To decrease the risk of infection, a woman should avoid intercourse, tampons, and douches for two weeks after the abortion.

A follow-up visit is a necessary part of the woman's aftercare. Contraception will be offered to women who wish to avoid future pregnancies, because menstrual periods normally resume within a few weeks.

Risks

Complications from abortions can include:

• uncontrolled bleeding
• infection
• blood clots accumulating in the uterus
• a tear in the cervix or uterus
• missed abortion (the pregnancy is not terminated)
• incomplete abortion where some material from the pregnancy remains in the uterus

Women who experience any of the following symptoms of post-abortion complications should call the clinic or doctor who performed the abortion immediately:

• severe pain
• fever over 100.4°F (38.2°C)
• heavy bleeding that soaks through more than one sanitary pad per hour
• foul-smelling discharge from the vagina
• continuing symptoms of pregnancy

Normal results

Usually the pregnancy is ended without complication and without altering future fertility.

Morbidity and mortality rates

Serious complications resulting from abortions performed before 13 weeks are rare. Of the 90% of women who have abortions in this time period, 2.5% have minor complications that can be handled without hospitalization. Less than 0.5% have complications that require a hospital stay. The rate of complications increases as the pregnancy progresses.

Only one maternal death occurs per 530,000 abortions performed at eight weeks gestation or less; this increases to one death per 17,000 abortions performed from 16 to 20 weeks, and one death per 6,000 abortions performed over 20 weeks.

Alternatives

Adoption is an option for pregnant women who do not want to raise a child but are unwilling or unable to have an abortion. Adoption agencies, crisis pregnancy centers, family service agencies, family planning clinics, or state social service agencies are available for women to contact for more information about the adoption process.

PERIODICALS

Centers for Disease Control and Prevention. "Abortion Surveillance—United States, 1999." Morbidity and Mortality Weekly Report 51 (2002): SS09.

Finer, L. B. and S. K. Henshaw. "Abortion Incidence and Services in the United States in 2000." Perspectives on Sexual and Reproductive Health 35 (2003): 6–15.

Jones, R. K., J. E. Darroch, and S. K. Henshaw. "Patterns in the Socioeconomic Characteristics of Women Obtaining Abortions in 2000–2001." Perspectives on Sexual and Reproductive Health 34 (2002): 226–35.

ORGANIZATION

Alan Guttmacher Institute. 1120 Connecticut Ave., NW, Suite 460, Washington, DC 20036. (202) 296-4012. <http://www.agi-usa.org>.

Centers for Disease Control and Prevention, Division of Reproductive Health. 4770 Buford Highway, NE, Mail Stop K-20, Atlanta, GA 30341-3717. (770) 488-5200. <http://www.prochoice.org>.

National Abortion Federation. 1755 Massachusetts Ave., NW, Suite 600, Washington, DC 20036. (202) 667-5881. <http://www.prochoice.org>.

Planned Parenthood Federation of America. 810 Seventh Ave., New York, NY 10019. (212) 541-7800. <http://www.plannedparenthood.org>.