Is a medical abortion dangerous?

 

Medical abortions performed in the first 10 weeks of pregnancy have a very low risk of complications. This risk is the same as when a woman has a natural miscarriage. These problems can easily be treated by a doctor. 

Out of every 100 women that do medical abortions, 2 or 3 women have to go to a doctor, first aid center, or hospital to receive further medical care. In countries where childbirth is safe, 1 in every 10.000 women dies during childbirth. Less than 1 in every 100,000 women who use a medical abortion die, making medical abortions safer than childbirth and about as safe as naturally occurring miscarriages. This means that a safe abortion with Mifepristone and Misoprostol is always lifesaving.

In Europe, more than 1.5 million women have terminated their pregnancies with mifepristone and misoprostol. Medical TOP is proven to be safe and effective, with few serious complications and success rates of 95–98%.2Mifepristone and misoprostol have been on the list of essentialmedicines of the World Health Organization since 2005. 

Medical abortion is safer than the use of antbiotics. The risk of fatal anaphylaxis with penicillin has previously been estimated as about 1 in 100 000[1]. Mortality of medical abortion is less than 1 per 250.000 women who do a medical abortion.

“Abortion care can be safely provided by any properly trained health-care provider, including midlevel (i.e.non-physician) providers (35, 6). The term “midlevel providers” in the context of this document refers to a range of non-physician clinicians (e.g. midwives, nurse practitioners, clinical officers, physician assistants, family welfare visitors, and others)”

 “Abortion care provided at the primary-care level and through outpatient services in higher-level settings is safe, and minimizes costs while maximizing the convenience and timeliness of care for the woman (7).”

“Allowing home use of misoprostol following provision of mifepristone at the health-care facility can further improve the privacy, convenience and acceptability of services, without compromising on safety (810). Inpatient abortion care should be reserved for the management of medical abortion for pregnancies of gestational age over 9 weeks (63 days) and management of severe abortion complications (see Chapter 2).”[2]

(Page 65 WHO report)

 

 

 

1 http://jac.oxfordjournals.org/content/60/5/1172.long
2 Significant adverse events and outcomes after medical abortion. Cleland K, at all Obstet Gynecol. 2013 Jan;121(1):166-71. doi: http://10.1097/AOG.0b013e3182755763.
3 WHO report: Safe abortion: technical and policy guidance for health systems, 2012. page 65

More scientific information:

Research has shown that very few serious complications result from medical abortions in comparison to the number of women who experience successful medical abortions. 16 17 20 21 22 In the few cases that a surgical intervention such as a curettage (vacuum aspiration) is needed, this can be managed by the same health care facilities that care for women who have had miscarriages.

 

Length of pregnancy% of women needing further medical care
0- 49 days (0-7 weeks)2 %
40-63 days (7-9 weeks)2.5%
64-70 days (9-10 weeks)2.7%
71-77 days (10-11 weeks)3.3%

 

2 or 3 out of every 100 women that have medical abortions will need to go to a local doctor, first aid center, or hospital to receive further medical care such as vacuum aspiration. This risk is equal to that of requiring medical care for an allergic reaction after using penicillin. 56 57(Further medical care consists of vacuum aspiration for a continuing pregnancy or an incomplete abortion.)

Medical abortion with Mifepristone and Misoprostol is used in most European countries. In France only about 1.000.000 abortions have been done with Mifepristone and Misoprostol since 1992 and no deaths have occurred.

As of January 2009, approximately 1,000,000 women in the United States and over 2 million women in Europe have used Mifepristone with Misoprostol to induce abortion, and there have been five deaths associated with the use of Mifepristone in medical abortion. 65
In 2005 the Food and Drug Administration (FDA) of the United States published a public health advisory concerning the use of Mifepristone and Misoprostol for medical abortion. In it, the FDA stated, “The risk of fatal sepsis in women undergoing medical abortion is very rare (approximately 1 in 100,000). 37 12 36

The chance of death due to a medical abortion is less than a 1 in 100,000. 9 19 Miscarriage (also called spontaneous abortion) is a relatively common occurrence associated with pregnancy, occurring in approximately 15 out of every 100 pregnancies. 35 The death rate associated with miscarriage in the United States was also less than 1 death per 100,000 miscarriages. 35 Thus the death rate associated with medical abortion is about the same as the death rate associated with miscarriage. 9 62

Compare this mortality rate with that of Viagra, a drug that treats erectile dysfunction.
As of early 2000, approximately 11 million prescriptions had been written for Viagra. 18 564 men had died as a result of using the drug, according to an article in the Journal of the American Medical Association. Based on the number of prescriptions written, that mortality rate is approximately 1 in every 20,000 prescriptions! As most men get more than 1 prescription, this means that the death rate is even higher than 1 in every 20,000 users. Apparently, the mortalities associated with Viagra have not been reason to remove this drug from the market.

Compare medical abortion's mortality rate with that of penicillin. Fatal reactions to penicillin occur in 1 case per 50,000-100,000 courses. 58 This means that a medical abortion is safer than a treatment with penicillin.

The risks associated with miscarriage and with safe and legal abortion “are substantially less than the risk of continuing the pregnancy." 9

In many countries, there are more deaths associated with childbirth than with induced abortion. The actual number of deaths from induced abortion are even fewer than what is shown in the following chart, since deaths related to induced abortion, miscarriage, and ectopic pregnancy are grouped in the same category. 41

 

CountryDeaths caused by miscarriage, ectopic pregnancy, abortionDeath caused by miscarriage, ectopic pregnancy, abortion per live birthPregnancy-related deaths, excluding abortionPregnancy-related deaths per live births
France21 in 387,000481 in 16,000
Australia00 per 246,000121 in 21,000
Canada11 in 328,000101 in 33,000

Source: WHO Mortality Database, 2001

 

Though complications can occur, medical abortion using this service is much less dangerous than having an unsafe abortion in places where it is severely restricted. 19 million unsafe abortions occur each year, and 68,000 of them directly result in the death of the woman.43 This means one in every 279 women undergoing an unsafe abortion dies unnecessarily.
For each of these 68,000 women, there are 30 more (totaling 2,040,000 women) that suffer pain and disability due to unsafe abortions.44 This means that 1 in every 9 women undergoing an unsafe abortion suffers long term complications unnecessarily.