The risks of complications following a surgical abortion are increased as gestational age rises. It is important to know and understand which procedures are used at various stages of pregnancy, and the complications that may arise. A sonogram is a useful tool used to pinpoint accurate gestational date and pregnancy viability. Some procedures can be carried out in a clinic or doctor's office, while others should only be carried out in a hospital setting due to the increased risk for complications.
Infection
The instruments used during procedures such as suction aspiration, which is performed early in pregnancy, can introduce foreign pathogens to the reproductive organs. As stated by the American Pregnancy Association, an infection due to an incomplete clearing of tissue can also result. Additionally, an STD or bacteria can be introduced into the uterus during the procedure. Infections can cause pain, fever, abdominal tenderness, or even scarring of the uterus, making future pregnancies difficult or impossible. Hospitalization may be necessary in some cases to treat the infection.
Perforation of the Uterus
In rare cases, the surgical instruments used for cervical dilation can perforate the uterus and other organs. This complication, which can occur during dilation and evacuation (D&E), is rare, according to the American Congress of Obstetricians and Gynecologist (ACOG). The procedure, which involves stretching the uterus to remove the fetal tissue, can be performed in a clinical setting at 12 to 15 weeks gestation. It often involves inserting an instrument called a laminaria into the cervix for several hours to remove fluid and cause the cervix to swell. A local anesthetic may be used, or in some cases, a general anesthesia is used. If other organs are damaged during this procedure, additional surgery may be necessary.
Asherman's Syndrome
The ACOG describes this as adhesions inside the uterus that can cause infertility and changes to menstrual flow. According to the Asherman's Syndrome website, the risk of developing Asherman's from a dilation & curettage (D&C) procedure increases with the number of D&Cs performed; after a single termination, the risk is 16 percent. These adhesions require surgery and can reform in the most serious cases.
Scarring of the Uterine Lining
Suction tubing and curettes, which are metal rods used for cervical dilation, as well as other abortion instruments may cause permanent scarring of the uterine lining. MayoClinic.com warns that surgical abortions do carry some risk of infertility issues following the surgery. Though rare, the cervix can become weaker with scarring and can require further surgery before conception and a successful full term pregnancy can occur.
Emotional Trauma
Dilation and Extraction, known commonly as partial birth abortion, is used when gestation has reached 21 weeks or more. The complications are similar to dilation and evacuation, although the American Pregnancy Association suggests that there is a particular risk of emotional complications due to advanced fetal development at the time of the procedure.
