Hemorrhage from Surgical Abortions
During operative pregnancy termination (vacuum aspiration or D&E) general anaesthetics (especially halothane or similar agents) appear to increase blood loss compared with local anaesthetics using intravenous narcotics and sedation.
Vasopressin, not epinephrine, can significantly reduce blood loss and reduce the risk of hemorrhage when injected into the paracervical area, especially in later gestations (≥ 15 weeks’ gestation). The difference in blood loss appears to be related to gestational age, and is significant in gestations of 15 weeks or greater.
Complete or partial perforation of the uterus is not uncommon. Risk factors beyond the control of the physician include gestational age, with a relative risk (RR) of 1.4 for each additional two weeks of gestation, and parity, with baseline RR 3.4 for the multiparous woman versus 1.0 for the nulliparous woman.
Factors that are within control of the physician are preprocedural cervical dilatation, type of anaesthetic, and experience. Use of osmotic dilators is associated with a RR of 0.2 of perforation, which is a significant decrease.
General anaesthetic use increases the RR of perforation to 1.3. The most important factors for the risk of perforation are training and experience as demonstrated by the increased RR of perforation up to 5.5 in procedures performed by residents compared with experienced physicians.
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.