Appendix: RCOG guidelines on 'Information
Taken from The
Care of Women Requesting Induced Abortion: Evidence-based Clinical
Guideline, Number 7, RCOG, September 2004, pp 29-35
Clinicians providing abortion services should possess
accurate knowledge about possible complications and sequelae of
abortion. This will permit them to provide women with the information
they need in order to give valid consent.
The risk of haemorrhage at the time of abortion is
low. It complicates around 1 in 1000 abortions overall. The risk
is lower for early abortions (0.88 in 1000 at less than 13 weeks;
4.0 in 1000 at more than 20 weeks).
The risk of uterine perforation at the time of surgical
abortion is moderate. The incidence is of the order of 1-4 in
1000. The risk is lower for abortions performed early in pregnancy
and those performed by experienced clinicians.
Uterine rupture has been reported in association
with mid-trimester medical abortion. However, the risk is very
low, at well under 1 in 1000.
Cervical trauma: the risk of damage to the external
cervical os at the time of surgical abortion is moderate (no greater
than 1 in 100). The risk is lower when abortion is performed early
in pregnancy and when it is performed by an experienced clinician.
Failed abortion and continuing pregnancy: all methods
of first-trimester abortion carry a small risk of failure to terminate
the pregnancy, thus necessitating a further procedure. The risk
for surgical abortion is around 2.3 in 1000 and for medical abortion
between 1 and 14 in 1000 (depending on the regimen used and the
experience of the centre).
Post-abortion infection: genital tract infection,
including pelvic inflammatory disease of varying degrees of severity,
occurs in up to 10% of cases. The risk is reduced when prophylactic
antibiotics are given or when lower genital tract infection has
been excluded by bacteriological screening.
Breast cancer: induced abortion is not associated
with an increase in breast cancer risk.
Future reproductive outcome: there are no proven
associations between induced abortion and subsequent ectopic pregnancy,
placenta praevia or infertility. Abortion may be associated with
a small increase in the risk of subsequent miscarriage or preterm
Psychological sequelae: some studies suggest that
rates of psychiatric illness or self-harm are higher among women
who have had an abortion compared with women who give birth and
to nonpregnant women of similar age. It must be borne in mind
that these findings do not imply a causal association and may
reflect continuation of pre-existing conditions.