California study finds abortion complications very rare

(Reuters Health) - Less than one quarter of one percent of abortion procedures result in major complications, a very low rate that is comparable to minor outpatient procedures in the U.S., according to a study of more than 50,000 women.

"We reviewed every emergency department visit in detail, all return visits to the original abortion provider, visits to primary care doctors, or any other health care provider and included any complications that were diagnosed or treated," the study's lead author told Reuters Health by email.

"Our results suggest that abortion is safe," said Ushma D. Upadhyay of the University of California, San Francisco. And the extremely low complication rate further suggests that state laws requiring abortion providers to have hospital admission privileges "will have limited benefits," she said.

The researchers used a database including more than 50,000 women covered by the fee-for-service California Medicaid program, Medi-Cal, who obtained an abortion in 2009 and 2010. The study noted any health care the women sought within six weeks following the procedure, including emergency room visits.

Almost 55,000 abortions were performed over the two-year period, with 6.4 percent of the women visiting the ER in the following six weeks, but most of those visits were for reasons unrelated to the procedure.

Less than one percent of abortions resulted in an ER visit related to the procedure and .03 percent involved an ambulance transfer on the day of the procedure.

Major complications, such as hemorrhage, which would require hospital admission, surgery or blood transfusion, occurred less than one third of one percent of the time for medication abortions and even less frequently for first trimester aspiration procedures.

Medication abortions have a slightly higher complication rate because sometimes tissue is left behind in the uterus and needs to be removed by aspiration, the authors write in the journal Obstetrics and Gynecology.

Since Medi-Cal beneficiaries tend to have more health problems and lower income than the general population, national complication rates may be even lower, Upadhyay said.

Any complications, major or minor, happened about two percent of the time, according to results. That can include retained tissue or blood clots in the uterus, infection, heavy bleeding, damage to the cervix or perforation, and allergic reactions to medications or anesthesia.

These results echo other complication rate estimates, but for the first time include ER visits as well, the authors note.

Abortion is actually as safe as, or safer than, colonoscopy, said Dr. Elizabeth Raymond, and has complication rates similar to outpatient plastic surgery or dental surgery.

Raymond, who was not part of the new study, is a senior medical associate at Gynuity Health Projects in New York.

In some cases, when women have to drive hundreds of miles each way to the nearest abortion provider, their risk of dying in a traffic accident on the way is greater than that for the procedure itself, she said.

"If we were really interested in increasing the safety of women having an abortion we would increase access," Raymond told Reuters Health by phone.

Many state legislatures have passed restrictions on abortion providers, for example 13 states require that abortion providers have hospital admitting privileges, with the stated aim to make the procedures safer for women.

Doctors and clinics that can't get admitting privileges are forced to stop providing services.

"Scarcity of abortion providers may cause delays in receiving abortion care, increased use of illegal abortion or self-induction, or more women forced to carry an unwanted pregnancy to term," said Upadhyay, who is part of a research think tank focused on evidence-based reproductive health policy within the UCSF Bixby Center for Global Reproductive Health.

"All of these pose a higher risk of complications than early legal abortion," she said.

When doctors are trained to perform the procedure in controlled circumstances, it is extremely safe, said Dr. Ian M. Bennett, associate professor of Family Medicine and Community Health at the Hospital of the University of Pennsylvania in Philadelphia, who was not part of the new study.

"It's at least ten times safer than the risk of going forward with the pregnancy," Bennett told Reuters Health by phone. Frequently, legislation like requiring admitting privileges is designed to limit abortion, and does not make sense given actual medical practice.

"I have admitting privileges in my hospital, but if a patient of mine had a complication and lived closer to another hospital she would go there," he said. Even if she returned to his hospital, he would most likely not be the one admitting her, Bennett said. "It's immaterial, it's entirely irrelevant."

SOURCE: Obstetrics and Gynecology, online December 8, 2014.