Abortion Complication Rates Low, Even With Follow-up Data

Larry Hand

December 09, 2014

Recent abortion complication rates in California are comparable to previously published rates, even when emergency department (ED) visits up to 6 weeks later are included in determining rates.

Ushma D. Upadhyay, PhD, MPH, assistant professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, and colleagues report the results of their analysis in an article published online December 5 in Obstetrics & Gynecology.

The investigators analyzed abortion data among women covered by the California Medicaid (Medi-Cal) fee-for-service program, plus all subsequent healthcare for 6 weeks after abortion including EDs visits for the years 2009 to 2010.

"We observed a 2.1% abortion-related complication rate after nearly 55,000 abortions diagnosed or treated at all sources of care," the researchers write. "The complication rate is much lower than that found during childbirth."

The analysis covers 54,911 abortions among 50,273 Medi-Cal fee-for-service beneficiaries. That represents about half of the abortions covered under Medi-Cal. The others are covered under managed care, but only fee-for-service records contain complete care information.

For those abortions, the researchers found that the abortion complication rate for all healthcare sources came to 2.1% (n = 1156) for medication abortion, 1.3% (n = 438) for first-trimester aspiration abortion, and 1.5% (n = 130) for second-trimester or later abortions. All rates are comparable to previously published rates even when postabortion care is included, the researchers write.

Among all patients, 6.4% (n = 3531) had ED visits within 6 weeks of the abortion, but 49.8% (n = 1758) of the visits were unrelated to the abortion.

Among all abortion-related ED visits (n = 1431), 21.8% (n = 770) followed a medication abortion, 64.2% (n = 2266) followed a first-trimester aspiration abortion, and 14.0% (n = 495) followed a second-trimester or later abortion.

Women who were 30 to 39 years old were more likely to have a complication than women who were 20 to 24 years old (relative risk [RR], 1.20, 95% confidence interval [CI], 1.02 - 1.40; P = .03).

Hispanic women were significantly less likely to have a complication than white women (RR, 0.76; 95% CI, 0.65 - 0.89; P < .001).

Women who had medication abortions were almost six times as likely to have complications as women who had first-trimester aspiration abortions (RR, 5.96; 95% CI, 5.11 - 6.94; P < .001).

Outpatient Centers Less Risky

Abortions at hospitals or physician or physician group offices carried significantly more risk than abortions performed at outpatient centers (RR, 4.74 [95% CI, 3.40 - 6.61] for hospitals and 1.70 [95% CI, 1.32 - 2.17] for physicians or physician's group offices; P < .001).

The records classified most complications as "other" or "undetermined" diagnoses.

The researchers point out that the complication rate may be overestimated in terms of generalizability. The study population has "higher rates of Hispanics, lower rates of blacks, and presumably higher rates of low-income women" than the national abortion population. "Medi-Cal beneficiaries may [also] have more health problems than the general population," they write.

The researchers cite states' efforts to regulate abortions "with the stated intent to increase safety. Given that in practice their ultimate effect often is the closure of abortion facilities, there is a need to consider the public health effect of these policies, weighing any theoretical incremental reduction in patient risk that may occur against any increases in risk that may occur with reduced access to abortion care."

The authors have disclosed no relevant financial relationships.

Obstet Gynecol. Published online December 5, 2014. Abstract

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