This complication occurs in approximately 2 per 1000 abortions performed at less than 12 weeks’ gestation. Several factors increase this complication.
1. Previous pregnancy: RR 2.2 for gravida greater than one
2. Gestational age: RR 2.9 for gestations less than six weeks
3. Small cannula size: RR11.1 if mm diameter is less than weeks of gestation for pregnancies less than six weeks
4. Uterine anomaly: RR 90.6
5. Physician training: RR 2.2 for residents
It is therefore necessary to inspect the tissue after every case to identify the products of conception and ensure that the abortion was successful.
Refer to SOGC’s Canadian Contraception Consensus.
All therapeutic abortion techniques require proper training.
Operators must be skilled, not only for the initiation of abortion, but also in the management of incomplete and failed procedures, uterine perforation, and such complications as hemorrhage, infection, and cervical laceration. Adequate training and ongoing experience using modern techniques with new methods will lead to a significant decrease in complication rates.
Summary of Recommendations
Victoria Jane Davis, MD
These guidelines were reviewed by the Clinical
Practice - Gynaecology Committee and the Social and Sexual
Issues Committee and approved by the Executive and Council of
the Society of Obstetricians and Gynaecologists of Canada.