Surgical intervention after medical abortion

Niinimäki and colleagues found a 10.7% rate of surgical intervention after medical abortion in adolescent women.1 This complication rate is important, because in 2009 in the UK, just over 40 000 women under 20 years underwent termination of pregnancy,2 40% by medical abortion, and the number of medical abortions is increasing.

A systematic review of premature delivery after induced abortion showed that the odds of premature delivery after induced surgical abortion (odds ratio 1.36, 95% confidence interval 1.24 to 1.50) increased with further surgical abortions (1.93, 1.28 to 2.71).3 Niinimäki and colleagues’ figures suggest that one in 10 young women who undergo medical abortions will be at risk of surgical intervention, and will then be at risk of subsequent premature delivery. One study estimated that induced surgical abortion accounts for 31.5% of the excess risk for births at less than 32 weeks’ gestation.4 Prematurity is a major risk factor for cerebral palsy.5

Providers of induced medical abortions should obtain informed consent from their clients in relation to the risks of failed medical abortion, which should include the risk of surgical evacuation, the subsequent risk for preterm delivery, and possible resulting neurological abnormality in their child.