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  • Title: [Complications of induced abortions].
    Author: Duprez D, Fortuna P.
    Journal: Soins Gynecol Obstet Pueric Pediatr; 1989 Feb; (93):23-6. PubMed ID: 2705090.
    Abstract:
    All physicians should be aware of the possible complications of induced abortions if only because the procedure is so commonplace. Some 250,000 induced abortions occur annually in France, amounting to 24.4 abortions per 100 live births. The rates of different complications of induced abortions before 12 weeks are .5-5/1000 for uterine perforation, .5-3.4% for hemorrhage with or without placental retention, 1% for endometritis, .3% for salpingitis .5% for continuing pregnancy, and .006 to .3/10,000 for death. A well done curettage is preferable to a poorly performed aspiration procedure. If an aspiration is done, the practitioner should bear in mind that retention of 50-200 cc of blood clots may occur if dilatation is insufficient. Symptoms appear 1-5 days after the abortion and end with expulsion of the clots or aspiration. Curettage is useless, as the clots do not represent a true retention. Uterine contractions during the aspiration can occasionally prompt a premature decision that evacuation is complete. Retention is difficult to diagnose immediately after aspiration but can be sonographically confirmed after the 8th day. Aspiration should be done after the 6th week and before the 12th week. Aspiration before the 6th week is often painful and is associated with higher rates of partial retention and of complete failure. Endouterine aspiration, regardless of technical proficiency, establishes a pathway between the vagina and the uterine cavity, which exposes the latter to the risk of trauma, endometrial lesions, and perforation. Induced abortion promotes infection by 2 mechanisms. Latent infections that were not detected in the medical history or physical examination can emerge and cause endometritis, which should be treated by ice, rest, and antibiotics. Or contamination of the passage by an infected cervical mucus can lead to salpingitis, abscess, and pelviperitonitis, or even general peritonitis. More often, these conditions develop from inadequately treated nonretentional endometritis. The condition should be treated with antibiotics and ice. Postoperative hemorrhage is unusual and is most frequently caused by retention. Psychological complications of abortion can be minimized by effective counseling. The counselor should seek to identify any history of psychological pathology or particularly stressful current situation. A certain amount of regret is a normal psychic response to abortion, but more serious symptoms such as suicidal thoughts or obvious depression may indicate the need for specialized care. Experience demonstrates that serious psychic reactions are rare and that a population at high risk can be defined. It includes very ambivalent women, those coerced into abortion, and those at the legal time limit. Women with a recent history of death or illness of a child, intrauterine death in the preceding pregnancy, or spontaneous abortions are also at risk.
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