Select Committee on Science and Technology Twelfth Report

Appendix: RCOG guidelines on 'Information for women'

Taken from The Care of Women Requesting Induced Abortion: Evidence-based Clinical Guideline, Number 7, RCOG, September 2004, pp 29-35

Recommendation 16

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.

Recommendation 16.1

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).

Recommendation 16.2

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.

Recommendation 16.3

Uterine rupture has been reported in association with mid-trimester medical abortion. However, the risk is very low, at well under 1 in 1000.

Recommendation 16.4

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.

Recommendation 16.5

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).

Recommendation 16.6

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.

Recommendation 16.7

Breast cancer: induced abortion is not associated with an increase in breast cancer risk.

Recommendation 16.8

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 delivery.

Recommendation 16.9

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.

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