Immediate complications after medical compared with surgical termination of pregnancy.
OBJECTIVE
To estimate the immediate adverse events and safety of medical compared with surgical abortion using high-quality registry data.


METHODS
All women in Finland undergoing induced abortion from 2000-2006 with a gestational duration of 63 days or less (n=42,619) were followed up until 42 days postabortion using national health registries. The incidence and risk factors of adverse events after medical (n=22,368) and surgical (n=20,251) abortion were compared. Univariable and multivariable association models were used to analyze the risk of the three main complications (hemorrhage, infection, and incomplete abortion) and surgical (re)evacuation.


RESULTS
The overall incidence of adverse events was fourfold higher in the medical compared with surgical abortion cohort (20.0% compared with 5.6%, P<.001). Hemorrhage (15.6% compared with 2.1%, P<.001) and incomplete abortion (6.7% compared with 1.6%, P<.001) were more common after medical abortion. The rate of surgical (re)evacuation was 5.9% after medical abortion and 1.8% after surgical abortion (P<.001). Although rare, injuries requiring operative treatment or operative complications occurred more often with surgical termination of pregnancy (0.6% compared with 0.03%, P<.001). No differences were noted in the incidence of infections (1.7% compared with 1.7%, P=.85), thromboembolic disease, psychiatric morbidity, or death.


CONCLUSIONS
Both methods of abortion are generally safe, but medical termination is associated with a higher incidence of adverse events. These observations are relevant when counseling women seeking early abortion.


METHODS
II.
Niinimäki
Maarit
M
From the Department of Obstetrics and Gynecology, Oulu University Hospital, the Graduate School of Circumpolar Wellbeing, Health and Adaptation, and the National Institute for Health and Welfare, Oulu, Finland; and the National Institute for Health and Welfare and the Nordic School of Public Health, the Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland.
Pouta
Anneli
A
Bloigu
Aini
A
Gissler
Mika
M
Hemminki
Elina
E
Suhonen
Satu
S
Heikinheimo
Oskari
O
D000019:Abortifacient Agents / Q000009:adverse effects*; D000028:Abortion, Induced / Q000009:adverse effects*; D000328:Adult; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D016017:Odds Ratio; D011247:Pregnancy; D012086:Reoperation; D014592:Uterine Hemorrhage / Q000209:etiology*; D014619:Vacuum Curettage / Q000009:adverse effects*; D055815:Young Adult
D000019:Abortifacient Agents