Medical Abortion - Health Risks

Health Risks

Reviews in 2004 and 2006 for the WHO Reproductive Health Library found that:

Medical methods for first trimester abortion have been demonstrated to be both safe and effective. Regimens that combine mifepristone or methotrexate with a prostaglandin such as misoprostol are more efficacious than a prostaglandin alone.

Prostaglandins alone seem to be less effective and more painful than surgical abortion. Evidence is inadequate on the acceptability and side-effects of the two methods. The medical approach avoids the use of anesthetics; this and the possibility of using it as an outpatient procedure may offer an advantage in under-resourced settings.

According to the 2006 WHO Frequently asked clinical questions about medical abortion, regarding factors that should be taken into account when counseling a woman about her choice between medical and surgical abortion:

There is little, if any, difference between medical and surgical abortion in terms of safety and efficacy. Thus, both methods are similar from a medical point of view and there are only very few situations where a recommendation for one or the other method for medical reasons can be given.

Medical abortion may be preferred:

• if it is the woman’s preference;
• in very early gestation; up to 49 days of gestation, medical abortion is considered to be more effective than surgical abortion, especially when clinical practice does not include detailed inspection of aspirated tissue;
• if the woman is severely obese (body mass index greater than 30) but does not have other cardiovascular risk factors, as surgical treatment may be technically more difficult;
• if the woman has uterine malformations or a fibroid uterus, or has previously had cervical surgery (which may make surgical abortion technically more difficult);
• if the woman wants to avoid a surgical intervention.

• if it is the woman’s preference, or if she requests concurrent sterilization;
• if she has contraindications to medical abortion;
• if time or geographical constraints preclude the follow-up needed to confirm that abortion is complete.

Since 2001, ten women—one in Canada, eight in the United States, one in Portugal—have died from clostridial toxic shock syndrome (nine from Clostridium sordellii, one from Clostridium perfringens) following early medical abortions using 200 mg mifepristone orally followed by 800 mcg misoprostol—nine vaginally, one buccally—without prophylactic antibiotics.

A retrospective study published in The New England Journal of Medicine in July 2009 of 227,823 women who underwent medical abortion at Planned Parenthood affiliate centers from January 2005 through June 2008, found that the rate of serious infection after medical abortion declined by 93% after a change from vaginal to buccal administration of misoprostol combined with the routine prophylactic administration of doxycycline antibiotics.

A table in the 2010 Handbook of Obstetric and Gynecologic Emergencies, 4th edition lists these possible complications of medical and surgical abortion:

• Medical abortion
  • Hemorrhage
  • Incomplete abortion
  • Uterine or pelvic infection
  • Ongoing intrauteine pregnancy, requiring a surgical abortion for completion
  • Misdiagnosed/unrecognized ectopic pregnancy
• Surgical abortion
  • Hemorrhage
  • Incomplete abortion
  • Uterine or pelvic infection
  • Ongoing intrauteine pregnancy, requiring a second procedure
  • Misdiagnosed/unrecognized ectopic pregnancy
  • Hematometra (blood clots accumulating in the uterus)
  • Uterine perforation
  • Cervical laceration