Abortion Complications: When You Should Seek Care.

From a medical perspective there are no major differences between a medical, a surgical and a spontaneous abortion because when complications arise the symptoms are fairly similar. So how does one know they are experiencing abnormal post abortion symptoms?

Is access to safe abortion the only step in successful termination?

As hard as it is to attain a safe abortion in many parts of the world, the hurdles do not stop there. Access to safe abortion is the first step to a successful termination. But an important and often neglected part of well-rounded abortion care is post-abortion care.

Before we delve into what post-abortion care is for, let us explain why there are more integral steps other than access. Failed abortions are fairly common in early gestation.

There are two types of abortions: spontaneous or miscarriage and induced abortion. In the first type, a woman’s body expels the products of conception on its own because of chromosomal abnormalities and congenital malformations. Basically, a woman’s body recognises that the foetus is not viable and therefore ejects it from the womb.

These types of abortions can also happen due to risks such as maternal infections and diseases, age, weight factors, poor prenatal care, and uterine abnormalities. ^[2]

Spontaneous miscarriages as is evident in their name are unavoidable or preventable. They can however happen partially where some of the conception products are left in the woman’s uterus, causing minor to severe complications.

An incomplete abortion is also a complication that happens when women seek induced abortions. These are abortions through either medication or surgery. In these types of abortions; infection, haemorrhage, and injury from the surgical procedures can occur. ^[2]

When we talk about infection, we are referring to septic abortions. These are common in unsafe abortions where the untrained provider does not use properly sterilised instruments. It is, therefore, less common in spontaneous and medical abortions. It is worth noting that septic infection can also happen in the presence of a pre-existing infection, such as an STI, endometritis, or cervical inflammation. ^[3]

Snapshot of the types of abortions:

• Miscarriages are abortions, and sometimes they happen partially, causing what we call incomplete abortion
• Incomplete abortions can also occur in induced abortions when the medication or surgical procedure leaves some of the conception products behind
• Septic abortions usually result from surgically induced abortions done by untrained practitioners using nonsterile techniques instruments.
• The frequency and severity of abortion complications depend on gestational age at the time of the abortion and the method of abortion
• Ultimately post-abortion complications happen because of three major things: incomplete evacuation, infection, and surgical injury or trauma. ^[1]
• Unsafe abortion methods that include non-medical remedies or unsterilised equipment are the primary source of abortion related health complications.

Symptoms and signs of post-abortion complications:

Now that we’ve seen how complications happen, we can talk about some common symptoms that may occur after an abortion.
Minor symptoms of post-abortion complications include light vaginal bleeding, low-grade fever, nausea, vomiting, diarrhoea, headache, abdominal cramps, fatigue ^[1]
Severe symptoms of post-abortion complications include excessive bleeding, progressively worsening lower abdominal, back, and/or pelvic pain, septic shock (will look like confusion or disorientation, shortness of breath, high heart rate, fever lasting more than 24 hours, or shivering, or feeling very cold), foul-smelling vaginal discharge ^[1]

What are the differences between after abortion symptoms:

The minor symptoms listed above are common for all types of abortions. In fact, in medical abortions, they are actually the normal side effects of the medication. These symptoms ease within a short period and often do not need a visit to the doctor. It is very important to always ask the service provider what to expect.

The severe symptoms, however, need immediate medical attention and should not be dismissed. As with any other medical issue, symptoms are indicative of what could be going on, for example, heavy postoperative bleeding could mean: ^[2]

• The uterus has failed to contract or return to normal- usually due to the collection of blood and or conception products that cause the uterus to swell and fail
• The uterus, bladder, or bowel has been injured,
• The woman’s inability to clot properly,
• Damage to tissue or organ caused by the application of unsafe medical devices

Severe post-abortion complications can lead to permanent outcomes with death being the worst and other extremes such as subsequent hysterectomy, uterine rupture, multisystem organ failure, cervical damage, infertility, and/or lasting psychological effects.

What to expect when seeking emergency treatment:

If a woman needs emergency treatment, examinations to expect are ^[3]

• Frequent monitoring of vital signs
• An abdominal exam to check for abdomen and organ damage
• A pelvic exam to check the severity of vaginal bleeding and or look for obvious vaginal or cervical damage
• A rectal exam to determine if there has been an injury to the bowel

Regardless of the type of abortion, all women need post-abortion care

Bearing in mind that miscarriages are abortions, means from a medical perspective there are no major differences between a medical, surgical, and spontaneous abortion. For example, the medication used in medical abortions can also be used to safely treat an incomplete miscarriage, so can surgical excavation. Furthermore, abortion complication symptoms, as we’ve covered them here, are very similar.

Nonetheless, legislation in many countries differentiates abortions, placing stigma on some abortions and making it difficult for women who have induced abortions to access PAC. Even so, research clearly shows that Comprehensive Abortion Care (CAC) also includes all of the elements of PAC, and together they contribute to vast reductions in maternal mortality. ^[5]

Treatment of incomplete and unsafe abortion and complications is therefore necessary for all women because they are potentially life-threatening and or life-altering.