Physical complications of abortion vary, depending on the age of the pregnancy and the type of abortion. In general, the risk of complications increases with gestational age past eight weeks.1 Some complications appear in the first hours following the abortion, while others may take days, weeks and even years to show up. Statistics on abortion complications are inconsistent and incomplete. Most studies focus on short-term complications, while later effects on both physical and psychological health are usually neglected.2
Short-term Health Risks
Long-term Health Risks
Risks in Future Pregnancies
Short-term Health Risks
Acute Hematometra (post-abortal 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.3,4,5
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.6,7,8
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.9,10,11,12
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.”13 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.14,15
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.16,17,18,19
Hemorrhage associated with surgical abortion is often caused by injury to the cervix or uterus, retained tissue, or failure of the uterus to contract.20,21
In later abortions, and saline abortions, the risk of a life-threatening complication called disseminated intravascular coagulation (DIC), along with hemorrhage, is increased.22,23,24
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.25
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.26 Low cervical perforations may injure the uterine artery and cause severe hemorrhage and death.27
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.28
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.29,30
Convulsion can be a true epileptic seizure, a reaction to anesthetics, or a hysterical manifestation.31
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.32,33 In fact, saline abortion has fallen out of favour because of this risk.34
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.35,36
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.37 Abortion can result in amniotic fluid and air embolism.38,39
Both local and general anesthesia in abortion have resulted in death.40,41 General anesthetic is used less often than local anesthetic,42 but both carry risks.
Pelvic Inflammatory Disease (PID)
The development of pelvic infection following abortion is one of the most commonly-occurring side effects. PID carries long-term risks of chronic pelvic pain, dyspareunia (pain during sexual intercourse), reduced fertility and ectopic pregnancy.43,44
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.45
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 1997.46
Long-term Health Risks
Hormonal factors, including estrogen, are well known to be connected to an increase in breast cancer risk. Cancer advocacy groups such as the Canadian Cancer Society also acknowledge this by mentioning several risk factors associated with increased estrogen exposure. Among the “Causes of breast cancer” listed on their website (www.cancer.ca) are: no childbirth, or first childbirth after age 30, early onset of menstruation, late menopause, taking combined hormone replacement therapy, and taking oral contraceptives. These risk factors are all associated with increased estrogen exposure.
Induced abortions increase a woman’s window of exposure to estrogen, in two basic ways. Abortions deny women the estrogen-balancing protective effects of a full term pregnancy as well as breast feeding. This is undisputed. A woman’s estrogen exposure is even more significant if she has an abortion before ever having a full term pregnancy, because it exposes rapidly-dividing, immature breast cells to massive amounts of estrogen. Obviously, abortions are performed on women who are already pregnant. Soon after conception occurs, estrogen levels surge, causing breast cells to multiply profusely. When such massive cell multiplication occurs, more errors or mutations can also occur, resulting in abnormal cells. Under the influence of estrogen, the abnormal cells also multiply, which can lead to cancer formation. Estrogen can also directly attack the DNA, causing more abnormal cells to form and multiply. Late in pregnancy, other hormones not only cause most of the breast cells to mature into milk-producing cells that are resistant to the damaging effects of estrogen, they also help to repair damage that may have occurred under the influence of estrogen. When induced abortion halts the normal protective hormonal process of progressive cell maturation and cell repair, more immature, rapidly-dividing breast cells are exposed to the effects of estrogen. Note that spontaneous abortion (miscarriage) usually occurs with low levels of pregnancy hormones, including estrogen, thus not increasing breast cancer risk.
Biology shows that estrogen, without the balancing effects of the other pregnancy hormones, is a factor in increased breast cancer risk. Induced abortion increases a woman’s total estrogen exposure, ultimately increasing her risk for breast cancer.
Beginning in 1957 and as current as the fall 2007 Journal of American Physicians and Surgeons, there have been more than 50 studies in peer-reviewed medical journals that have shown an increased risk of breast cancer among women who have had induced abortions.
In addition there have been three medical malpractice lawsuits since 2002 in which the failure to warn women about the abortion-breast cancer link has resulted in two out-of-court settlements and one adjudicated judgment, all in favour of the post-abortive women who brought the suits forward.
For more information on abortion and breast cancer, with references, go to www.abortionbreastcancer.ca .
Induced abortion may be a contributing factor to future infertility, with symptoms often appearing years after the abortion when the woman attempts to conceive a child. The complications negatively influencing future fertility include post-abortal Pelvic Inflammatory Disease (PID), uterine perforations causing scar tissue, uterine adhesions and retained fetal fragments, or endometrial ossification. Women whose first pregnancies end in abortion are at particular risk for future problems with fertility.47
Risk in Future Pregnancies
Pre-term birth (premature birth)
Induced abortion has been found to increase pre-term birth (before 33 weeks’ gestation) and early pre-term birth (20-30 weeks’ gestation) in following pregnancies. The risk increases with more abortions. Abortion can cause cervical injuries resulting in incompetent cervix, which is a risk factor for pre-term birth. Abortion is also associated with uterine scarring, adhesions and infection, which in turn increase the risk for pre-term birth. Pre-term birth is an important risk factor for cerebral palsy.48,49
Abortion is associated with placenta previa in future pregnancies.50 The placenta attaches very low in the uterus, partly covering the cervical opening. Placenta previa increases the risk for bleeding during pregnancy and labor, and can result in premature separation of the placenta, severe hemorrhage and fetal death.51
When an RH negative mother carrying an RH positive fetus delivers her child, either through birth or abortion, the mother may become sensitized to RH antigens. The fetus’ RH antigens enter the mothers’ blood stream, stimulating her to develop anti-RH antigens. In future pregnancies with RH positive fetus’ these may cross back through the placenta and cause clumping of the fetus’s red blood cells, causing nerve and brain damage. Sensitization can also cause serious consequences with clumping of blood if the woman is ever transfused with RH positive blood.
RH sensitization is avoidable in childbirth and abortion with an immunization of the mother following delivery.52,53
Abortion has been shown to be a risk factor for future ectopic pregnancy.
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2 Heath Care Statistics Section, Health Statistics Division. “Therapeutic Abortion Survey, June 2007: 2004-A.”
3 Stubblefield. et al. p. 174-175.
4 Grimes DA and Creinin MD. “Induced abortion: an overview for internists.” Annals of Internal Medicine 2004:140: 624.
5 Neubardt S, Schulman H. “Techniques of Abortion, 2nd Ed.” Little, Brown and Company Inc., 1977: 51.
6 Stubblefield. et al. p. 174-175.
7 Grimes. et al. p. 624.
8 Hern WM. “Abortion Practice.” J.B. Lippincott Company, 1984: 180-181.
9 Stubblefield. et al. p. 177.
10 Fischer MD, Bhatnagar J, Guarner J, Reagan S, Hacker JK, Van Meter SH, Poukims V, Whiteman DB, Iton A, Cheung M, Dassey MD, Shieh WJ, Zaki SR. “Fatal toxic shock syndrome associated with clostridium sordiellii after medical abortion.” New England Journal of Medicine Dec 1, 2005; 353(22): 2352-2360.
11 Creinin M, Blumenthal P, Shulman L. “Mifepristone-Misoprostol Medical Abortion Mortality.” Medscape General Medicine 2006; 8(2): 1-4.
12 Laliberte J. “Still no mifepristone for Canada: is it safe?” National Review of Medicine Sept 30, 2005; 2(16):1-2.
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14 Hern. p. 194, 202, 203.
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16 Stubblefield. et al. p. 177.
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20 Stubblefield. et al. p. 175-178.
21 Hern. p. 192.
22 Stubblefield. et al. p. 178.
23 Hern. p. 201.
24 Neubardt. et al. p. 88-89, 94.
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26 Hern. p. 181, 194-195.
27 Stubblefield. et al. p. 175.
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29 Hern. p. 191.
30 Neubardt. et al. p. 49.
31 Neubardt. et al. p. 49.
32 Neubardt. et al. p. 83.
33 Hern. p. 190.
34 Stubblefield. et al. p. 178-179.
35 Stubblefield. et al. p. 178.
36 Hern. p. 193.
37 Miller. et al. p. 483-484.
38 Hern. p. 138, 149, 182, 199.
39 Stubblefield. et al. p. 178-179.
40 Hern. p. 35-38.
41 Stubblefield. et al. p. 174.
42 Grimes. et al. p. 621.
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44 Sorensen JL, Thranov I, Hoff G, Dirach J, Damsgaard MT. “A double-blind randomized study of the effect of erythromycin in preventing pelvic inflammatory disease after first-trimester abortion.” British Journal of Obstetrics and Gynaecology 1992 May: 99(5): 436.
45 Ring-Cassidy E, Gentles I. “Women’s Health after Abortion: The Medical and Psychological Evidence.” The deVeber Institute for Bioethics and Social Research: Toronto, Ontario, 2003: 86.
46 Gissler M, Kauppila R, Merilainen J, Toukomaa H, Hemminki E. “Pregnancy-associated deaths in Finland 1987-1994-definition problems and benefits of record linkage.” Acta Obstetricia et Gynecologica Scandanavica 1997 Aug; 76(7):651-7
47 Ring-Cassidy. et al. p. 65.
48 Rooney. et al. p. 46-47.
49 Thorpe JM, Hartmann KE, Shadigan E. Long-term physical and psychological health consequences of induced abortion: review of the evidence. Obstetrical and Gynecologic Survey 2002;58(1):70.
50 Thorpe. et al. p. 70.
51 Miller. et al. p. 1163-1164.
52 Miller. et al. p. 1308.
53 Neubardt. et al. p. 52, 58-59.