eMedicine Specialties > Emergency Medicine > Obstetrics & Gynecology

Abortion, Complications

Slava V Gaufberg, MD, Assistant Professor of Medicine, Harvard Medical School; Director of Transitional Residency Training Program, Cambridge Health Alliance

Updated: Dec 12, 2008

Introduction

Background

Complications of spontaneous and therapeutic abortions include (1) complications of anesthesia, (2) postabortion triad (ie, pain, bleeding, low-grade fever), (3) hematometra, (4) retained products of conception, (5) uterine perforation, (6) bowel and bladder injury, (7) failed abortion, (8) septic abortion, (9) cervical shock, (10) cervical laceration, and (11) disseminated intravascular coagulation (DIC).

Pathophysiology

Postabortion complications develop as a result of 3 major mechanisms as follows: (1) incomplete evacuation of the uterus and uterine atony, which leads to hemorrhagic complications, (2) infection, and (3) instrumental injury.

Frequency

United States

Frequency of complications depends on gestational age (GA) at time of abortion and method of abortion. Complication rates according to GA at time of abortion are as follows: 

• 8 weeks and under - Less than 1% 
• 8-12 weeks - 1.5-2% 
• 12-13 weeks - 3-6% 
• Second trimester - Up to 50%, possibly higher

Mortality/Morbidity

Mortality and morbidity depend on gestational age (GA) at time of abortion. In the US, mortality rates per 100,000 abortions are as follows: (1) fewer than 8 weeks, 0.5; (2) 11-12 weeks, 2.2; (3) 16-20 weeks, 14; and (4) more than 21 weeks, 18.

Clinical

History

Presentation depends on the type of complication the patient develops.

• Intraoperative and early postoperative complications rarely are seen in the ED, but some patients develop these types of complications and present to the ED for treatment. Complications include the following:
  • Local anesthesia: Paracervical block is common method of anesthesia for therapeutic abortion. Accidental intravascular injection of anesthetic is a potentially life-threatening complication of this method that could lead to convulsion, cardiopulmonary arrest, and death.
  • General anesthesia: Complications with general anesthesia may lead to uterine atony with severe hemorrhage.
  • Cervical shock: Vasovagal syncope produced by stimulation of the cervical canal during dilatation may occur. Rapid recovery usually follows.
  • Postabortion triad: Pain, bleeding, and low-grade fevers are the most common presenting complaints. Postabortion triad usually is caused by retained products of conception.
  • Hemorrhage: Excessive hemorrhage during or after abortion may signify uterine atony, cervical laceration, uterine perforation, cervical pregnancy, a more advanced GA than anticipated, or coagulopathy.
  • Hematometra: Patients usually present with persistent postabortion bleeding and increased lower midline abdominal pain.
  • Perforation: Patients with uterine perforation missed during the procedure usually present to the ED with increased abdominal pain, bleeding (possibly ranging from very mild to absent), and fever. If perforation results in injury to major blood vessels, patients may present in hemorrhagic shock.
  • Bowel injury: This may accompany uterine perforation. If initially unrecognized, patients present with abdominal pain, fever, blood in the stool, nausea, and vomiting.
  • Bladder injury: This occurs as a result of uterine or cervical perforation. Patients present with suprapubic pain and hematuria.
  • Septic abortion: Patients present with fever, chills, abdominal pain, and vaginal bleeding.
  • Failed abortion (continued intrauterine or ectopic pregnancy): Failure to terminate pregnancy is relatively common with very early abortions (<6 wk GA). Such patients may present to the ED with symptoms of continuing pregnancy such as hyperemesis, increased abdominal girth, and breast engorgement. In addition, an unrecognized ectopic pregnancy in the postabortion period presents in the usual manner.
  • DIC: Suspect DIC in all patients who present with severe postabortion bleeding, especially after midtrimester abortions. Incidence is approximately 200 cases per 100,000 abortions; this rate is even higher for saline instillation techniques (660 per 100,000 abortions).

Physical

• Vital signs
  • Monitoring of vital signs is essential for patients with postabortion complications.
  • Increasing fever could be a sign of progressing infection.
  • Tachycardia and hypotension may be signs of severe hemorrhage or septic shock.
• Abdominal examination
  • Suprapubic tenderness is common in the postabortion period. Severe tenderness is unusual, however, and may be a sign of hematometra, bladder perforation, or bowel injury.
  • Tenderness in other areas of the abdomen (eg, rebound tenderness, guarding) strongly indicates instrumental injury complications (eg, perforation, bowel injury, bladder injury).
  • A tender mass in suprapubic area suggests hematometra.
  • Diminished or absent bowel sounds are a sign of developing peritonitis.
• Vaginal examination
  • Assess the quantity and rate of hemorrhage.
    • Look for possible vaginal or cervical injury.
    • Identify the source of bleeding (eg, uterine, cervical os, lesions of vulva, vagina, or vaginal portion of cervix).
  • Cervical motion tenderness on bimanual examination may be suggestive of pelvic infection or ectopic pregnancy.
  • A large tender uterus may be a sign of hematometra.
  • Adnexal tenderness or masses may suggest ectopic pregnancy, pelvic inflammatory disease (PID), cyst, or hematoma.
• Rectal examination
  • Rectal examination must be performed if bowel injury is suspected.
  • Presence of rectal tenderness and blood (or guaiac-positive stool) makes the diagnosis of bowel injury almost certain.

Differential Diagnoses

Other Problems to Be Considered

Perforated viscus
Acute peritonitis

Workup

Laboratory Studies

• Complete blood count, platelets
• Complete metabolic screen
• Beta-human chorionic gonadotropin, quantitative level may provide useful information and a basis for future comparison.
• Prothrombin time/activated partial thromboplastin time
• Urinalysis
• Type and screen or type and cross with antibody screen (with severe hemorrhage)
• Fibrinogen and fibrin split products if DIC is suspected
• D-dimer

Imaging Studies

• To exclude free air as a result of bowel perforation, perform either upright chest x-ray or upright abdominal x-ray.
• Order or perform ultrasound with a vaginal probe to rule out ectopic pregnancy, retained products of conception, and hematometra.
• Order arteriography if injury to large blood vessels is suspected.

Treatment

Prehospital Care

Monitor vital signs and provide fluid resuscitation if the patient is hemodynamically unstable.

Emergency Department Care

Screen all patients with postabortion complications for Rh factor. Administer Rho(D) immune globulin (RhoGAM) if results indicate that the patient is Rh-negative and unsensitized.

• Patients with the postabortion triad (ie, pain, bleeding, low-grade fever) may respond to treatment with oral antibiotics and ergot preparations. Immediately initiate these agents. In most cases, however, blood clots or retained products of conception must be evacuated from the uterus. In these cases, administer medications parenterally, as the patient will undergo anesthesia.
• Hemorrhage or hematometra
  • Monitor vital signs and rate of bleeding. Administer fluids and blood as needed.
  • Administer IV oxytocin for treatment of uterine atony.
  • Alternative treatments for uterine atony include intracervical vasopressin or carboprost tromethamine and bimanual uterine massage.
  • If bleeding persists, screen for coagulopathy/DIC and obtain immediate gynecologic consultation with the intention of transferring the patient to the operating room (OR) for repeat curettage and, if necessary, hysterectomy.
• Uterine perforation, bowel injury, and bladder injury: If one or any combination of these complications is suspected or diagnosed in the ED, treat as follows.
  • Hemodynamically stabilize the patient.
  • Insert a Foley catheter.
  • Transfer to the OR for laparoscopy/laparotomy and further treatment.
• Failed abortion, continued pregnancy, and ectopic pregnancy
  • If the patient is stable, perform ultrasound and a beta-human chorionic gonadotropin (hCG) test to establish diagnosis and further treatment.
  • If the patient is unstable, transfer to the OR for dilation and curettage (D&C) and/or laparoscopy/laparotomy.

Consultations

• Consult an obstetrician/gynecologist (OB/GYN) in all cases of postabortion complications.
• Consult surgery and urology if bowel or bladder injury is diagnosed.

Medication

The goals of pharmacotherapy are to eradicate the infection, reduce morbidity, and prevent complications.

Antibiotics

Immediately administer broad-spectrum antibiotics to patients with severe postabortion infection.

Cefoxitin (Mefoxin)

Indicated for infections caused by susceptible gram-positive cocci and gram-negative bacilli. Many infections caused by gram-negative bacteria resistant to some cephalosporins and penicillins respond to cefoxitin.

Dosing

Adult

2 g IV q6h and 100 mg IV doxycycline q12h; continue at least 4 d and at least 48 h after improvement; then 100 mg PO doxycycline bid 10-14 d

Pediatric

Not established

Interactions

Probenecid may increase effects of cefoxitin; coadministration with aminoglycosides or furosemide may increase nephrotoxicity (closely monitor renal function)

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Bacterial or fungal overgrowth of nonsusceptible organisms may occur with prolonged use or repeated treatment; caution in patients with previously diagnosed colitis

Doxycycline (Bio-Tab, Doryx, Vibramycin)

Treats infections caused by susceptible gram-negative and gram-positive organisms, in addition to infections caused by susceptible Rickettsia, Chlamydia, and Mycoplasma species.

Dosing

Adult

100 mg IV q12h and 2 g IV cefoxitin q6h; continue at least 4 d and at least 48 h after patient improves; then 100 mg PO doxycycline bid 10-14 d

Pediatric

<12 years: Not established
>12 years: Administer as in adults

Interactions

Bioavailability decreases with antacids containing Al, Ca, Mg, Fe, or Bi subsalicylate; tetracyclines can increase hypoprothrombinemic effects of anticoagulants; tetracyclines can decrease effects of PO contraceptives, causing breakthrough bleeding and increased risk of pregnancy

Contraindications

Documented hypersensitivity, severe hepatic dysfunction

Precautions

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (last half of pregnancy through age 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines

Gentamicin sulfate (Garamycin, Gentacidin)

Aminoglycoside antibiotic for gram-negative coverage. Used in combination with both an agent against gram-positive organisms and an agent that covers anaerobes. Not the DOC. Consider if penicillins (see note above) or other less toxic drugs are contraindicated, when clinically indicated, and in mixed infections caused by susceptible staphylococci and gram-negative organisms. Dosing regimens are numerous; adjust dose based on CrCl and changes in volume of distribution. May be administered IV/IM.

Dosing

Adult

Serious infections and normal renal function: 3 mg/kg/d IV q8h; monitor renal levels
Life-threatening infections: 5 mg/kg/d IV q6-8h; monitor renal levels
Maintenance dose: 1-2.5 mg/kg IV and 1-1.5 mg/kg IV, respectively, q8h; monitor renal levels

Pediatric

<12 years: Not established
>12 years: 1.5-2.5 mg/kg/dose IV q8h or 6-7.5 mg/kg/d IV divided q8h; not to exceed 300 mg/d; monitor renal levels, adjust for renal function as needed; monitor renal levels as in adults

Interactions

Coadministration with other aminoglycosides, cephalosporins, penicillins, and amphotericin B may increase nephrotoxicity; aminoglycosides enhance effects of neuromuscular blocking agents; thus, prolonged respiratory depression may occur; coadministration with loop diuretics may increase auditory toxicity of aminoglycosides; possible irreversible hearing loss of varying degrees may occur (monitor regularly)

Contraindications

Documented hypersensitivity, non–dialysis-dependent renal insufficiency

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Narrow therapeutic index (not intended for long-term therapy); caution in renal failure (not on dialysis), myasthenia gravis, hypocalcemia, and conditions that depress neuromuscular transmission; adjust dose in renal impairment

Ticarcillin and clavulanate potassium (Timentin)

Presumptive therapy prior to identification of organism. Inhibits biosynthesis of cell wall mucopeptide; effective during stage of active growth.

Dosing

Adult

<60 kg: 200-300 mg/kg/d IV divided q4-6h
>60 kg: 3.1 g IV q4-6h or 200-300 mg/kg/d in equally divided doses q4-6h; not to exceed 18-24 g/d

Pediatric

Administer as in adults

Interactions

Tetracyclines may decrease effects; high concentrations of ticarcillin may physically inactivate aminoglycosides if administered in same IV line; effects when administered concurrently with aminoglycosides are synergistic; probenecid may increase penicillin levels

Contraindications

Documented hypersensitivity; severe pneumonia, bacteremia, pericarditis, emphysema, meningitis, and purulent or septic arthritis should not be treated with PO penicillins during acute stage

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Perform CBCs prior to initiation of therapy and at least weekly during therapy; monitor for liver function abnormalities by measuring AST and ALT during therapy; exercise caution in patients diagnosed with hepatic insufficiencies; perform UA and BUN and creatinine determinations during therapy and adjust dose if values become elevated; monitor blood levels to avoid possible neurotoxic reactions

Ampicillin and sulbactam sodium (Unasyn)

Drug combination of beta-lactamase inhibitor with ampicillin. Covers skin, enteric flora, and anaerobes. Not ideal for nosocomial pathogens.

Dosing

Adult

1.5 (1 g ampicillin + 0.5 g sulbactam) to 3 g (2 g ampicillin + 1 g sulbactam) IV/IM q6-8h; not to exceed 4 g/d sulbactam

Pediatric

Not established for pediatric patients with intra-abdominal infections
>40 kg: Administer as in adults

Interactions

Probenecid and disulfiram elevate ampicillin levels; allopurinol decreases ampicillin effects and has additive effects on ampicillin rash; may decrease effects of PO contraceptives

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Adjust dose in renal failure; evaluate rash and differentiate from hypersensitivity reaction

Imipenem and cilastatin sodium (Primaxin)

Treats multiple-organism infections for which other agents lack wide-spectrum coverage or are contraindicated due to potential toxicity.

Dosing

Adult

250-500 mg IV divided q6h; not to exceed 3-4 g/d, based on severity of infection
Alternatively, administer 500-750 mg IM or intra-abdominally q12h

Pediatric

15-25 mg/kg/dose IV q6h; maximum daily dose for fully susceptible organisms is 2 g/d; for infections with moderately susceptible organisms, maximum dose is 4 g/d

Interactions

Coadministration with cyclosporine may increase CNS adverse effects of both agents; coadministration with ganciclovir may result in generalized seizures

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Adjust dose in renal insufficiency

Piperacillin and tazobactam sodium (Zosyn)

Treats septicemia caused by susceptible organisms.

Dosing

Adult

12 g piperacillin + 1.5 g tazobactam IV in equally divided doses of 3 g q6h for 7-10 d

Pediatric

<12 years: Not established
>12 years: Administer as in adults

Interactions

Tetracyclines may decrease effects of ticarcillin; high concentrations of ticarcillin may physically inactivate aminoglycosides if administered in same IV line; effects when administered concurrently with aminoglycosides are synergistic; probenecid may increase penicillin levels

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Perform CBCs prior to initiation of therapy and at least weekly during therapy; monitor for liver function abnormalities by measuring AST and ALT during therapy; exercise caution in patients diagnosed with hepatic insufficiencies; perform UA and BUN and creatinine determinations during therapy and adjust dose if values become elevated; monitor blood levels to avoid possible neurotoxic reactions

Clindamycin (Cleocin)

Useful as treatment against aerobic streptococci and most staphylococci. Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

Dosing

Adult

Serious infections due to aerobic and anaerobic organisms: 600-1200 mg/d IV divided q6-8h

Pediatric

8-16 mg/kg/d IV divided tid/qid
Severe infections: 16-20 mg/kg/d divided tid/qid

Interactions

Increases duration of neuromuscular blockade, induced by tubocurarine and pancuronium; erythromycin may antagonize effects; antidiarrheals may delay absorption

Contraindications

Documented hypersensitivity; pseudomembranous colitis; hepatic impairment

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Adjust dose in severe hepatic dysfunction; no adjustment necessary in renal insufficiency; associated with severe and possibly fatal colitis

Cefotaxime (Claforan)

Treats septicemia and gynecologic infections caused by susceptible organisms. Arrests bacterial cell wall synthesis, which, in turn, inhibits bacterial growth.

Dosing

Adult

Moderate-to-severe infections: 1-2 g IV/IM q6-8h
Life-threatening infections: 1-2 g IV/IM q4h

Pediatric

<12 years: Not established
>12 years: Administer as in adults

Interactions

Probenecid may increase cefotaxime levels; coadministration with furosemide and aminoglycosides may increase nephrotoxicity

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Adjust dose in severe renal impairment; has been associated with severe colitis

Vancomycin HCL (Vancocin, Vancoled)

Potent antibiotic directed against gram-positive organisms and active against enterococcal species. Useful in the treatment of septicemia and skin structure infections. Indicated for patients who cannot receive or have failed to respond to penicillins and cephalosporins or who have infections with resistant staphylococci. To avoid toxicity, current recommendation is to assay only vancomycin trough levels after the third dose, drawn 0.5 h before next dosing. Doses and dosing intervals may be adjusted based on CrCl.

Dosing

Adult

500 mg/d to 2 g/d IV tid/qid for 7-10 d

Pediatric

40 mg/kg/d IV divided tid/qid for 7-10 d

Interactions

Erythema, histaminelike flushing and anaphylactic reactions may occur when administered with anesthetic agents; taken concurrently with aminoglycosides, risk of nephrotoxicity may increase above that with aminoglycoside monotherapy; effects in neuromuscular blockade may be enhanced when coadministered with nondepolarizing muscle relaxants

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Caution in renal failure, neutropenia; "red man" syndrome is caused by too rapid IV infusion (dose administered over a few min) but rarely happens when dose given as 2-h administration or as PO or IP administration; red man syndrome is not an allergic reaction

Ergot alkaloids

Ergot derivatives are used for oxytocic effects on uterine muscle. These agents prevent postabortion uterine atony and hemorrhage.

Ergonovine maleate (Ergotrate Maleate)

Prevents and treats postabortal hemorrhage due to uterine atony by producing a firm contraction of the uterus within minutes. Although intended primarily for IM administration, faster response can be achieved through IV administration. However, because IV route produces higher incidence of adverse effects, reserve for emergencies such as excessive uterine bleeding. Severe uterine bleeding may require repeated doses but seldom requires more than 1 injection q2-4h.

Dosing

Adult

0.2 mg IM/IV repeat q2-4h if needed

Pediatric

Not established

Interactions

Concurrent administration of methylergonovine with vasoconstrictors or other ergot alkaloids may produce additive effect

Contraindications

Documented hypersensitivity; not to be used in cases of threatened spontaneous abortion

Precautions

Pregnancy

X - Contraindicated; benefit does not outweigh risk

Precautions

Discontinue if ergotism develops; caution in heart disease, hypertension, mitral-valve stenosis, venoatrial shunts, sepsis, obliterative vascular disease, or hepatic or renal impairment

Methylergonovine (Methergine)

Acts directly on the smooth muscle of the uterus; induces a rapid and sustained tetanic uterotonic effect that reduces bleeding.

Dosing

Adult

0.2 mg IM
Severe uterine bleeding: Repeat doses q2-4h; same dose may be administered IV to produce quicker response; however, because IV route produces higher incidence of adverse effects, reserve for emergencies such as excessive uterine bleeding

Pediatric

Not established

Interactions

Concurrent administration of methylergonovine with vasoconstrictors or other ergot alkaloids may produce additive effect

Contraindications

Documented hypersensitivity; glaucoma; Tourette syndrome; anxiety

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Caution in sepsis, obliterative vascular disease, or hepatic or renal insufficiency

Follow-up

Further Inpatient Care

• Inpatient treatment includes repeat D&C, laparoscopy, and laparotomy (for treatment of complicated perforation, bowel and bladder injuries, refractory bleeding).

Further Outpatient Care

• If the patient is discharged from the ED, arrange definite follow-up care in 1-2 days with primary gynecologist.

Deterrence/Prevention

• Educate patients about contraceptive measures to deter them from using abortion as a means of birth control.

Patient Education

• For excellent patient education resources, visit eMedicine's Pregnancy and Reproduction Center and Procedures Center. Also, see eMedicine's patient education articles Miscarriage, Abortion, and Dilation and Curettage (D&C).

Miscellaneous

Medicolegal Pitfalls

• Do not underestimate the amount and rate of bleeding. In the supine position, more than 500 cc of blood may collect in the vagina without severe external bleeding. Always perform a pelvic examination on a postabortion patient who is bleeding.
• Aggressively treat vaginal bleeding even if it seems minimal. Stabilize the patient with 2 large-bore IVs and with oxygen. Closely monitor vital signs.
• In postabortion patients with abdominal pain beyond the pelvic area, suspect perforation and evaluate with KUB/upright x-rays and pelvic ultrasound. Consult a gynecologist and, if suspicion is high, insist on laparoscopy.
• The chance of a missed ectopic pregnancy always exists. Do not presume intrauterine pregnancy in a patient who has just had an abortion; she may have had a missed ectopic pregnancy.
• Do not delay administration of antibiotics if a patient has signs of severe postabortion infection. Administer broad-spectrum antibiotics before completing diagnostic workup.

References

1. Darney PD, ed. Handbook of Office and Ambulatory Gynecologic Surgery. Blackwell Science Inc; 1987:108.

2. Grimes DA, Cates W Jr. Deaths from paracervical anesthesia used for first-trimester abortion, 1972-1975. N Engl J Med. Dec 16 1976;295(25):1397-9. [Medline].

3. Grossman D, Blanchard K, Blumenthal P. Complications after second trimester surgical and medical abortion. Reprod Health Matters. May 2008;16(31 Suppl):173-82:[Medline].

4. Hakim-Elahi E, Tovell HM, Burnhill MS. Complications of first-trimester abortion: a report of 170,000 cases. Obstet Gynecol. Jul 1990;76(1):129-35. [Medline].

5. Lohr PA. Surgical abortion in the second trimester. Reprod Health Matters. May 2008;16(31 Suppl):151-61:[Medline].

6. Sam C, Hamid MA, Swan N. Pyometra associated with retained products of conception. Obstet Gynecol. May 1999;93(5 Pt 2):840. [Medline].

7. Shannon C, Brothers LP, Philip NM, Winikoff B. Infection after medical abortion: a review of the literature. Contraception. Sep 2004;70(3):183-90. [Medline].

8. Shulman SG, Bell CL, Hampf FE. Uterine perforation and small bowel incarceration: sonographic and surgical findings. Emerg Radiol. Aug 16 2006;[Medline].

9. Stuart GS, Sheffield JS, Hill JB, et al. Morbidity that is associated with curettage for the management of spontaneous and induced abortion in women who are infected with HIV. Am J Obstet Gynecol. Sep 2004;191(3):993-7. [Medline].

10. Stubblefield PG. First and second trimester abortion. In: Nichols DH, ed. Gynecologic and Obstetric Surgery. Mosby-Year Book; 1993:1016-1030.

11. Stubblefield PG. Pregnancy termination. In: Obstetrics: Normal and Problem Pregnancies. 3^rd ed. Churchill Livingstone; 1996:1249-1276.

12. Stubblefield PG, Grimes DA. Septic abortion. N Engl J Med. Aug 4 1994;331(5):310-4. [Medline].

Keywords

miscarriage, abortion complications, spontaneous abortion, therapeutic abortion, postabortion complications, complications of anesthesia, postabortion triad, vaginal bleeding, hematometra, retained products of conception, uterine perforation, bowel and bladder injury, failed abortion, septic abortion, cervical shock, cervical laceration, disseminated intravascular coagulation, DIC, complications of abortion

Contributor Information and Disclosures

Author

Slava V Gaufberg, MD, Assistant Professor of Medicine, Harvard Medical School; Director of Transitional Residency Training Program, Cambridge Health Alliance
Slava V Gaufberg, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Roy Alson, MD, PhD, FACEP, FAAEM, Associate Professor, Department of Emergency Medicine, Wake Forest University School of Medicine; Medical Director, Forsyth County EMS; Deputy Medical Advisor, North Carolina Office of EMS; Associate Medical Director, North Carolina Baptist AirCare
Roy Alson, MD, PhD, FACEP, FAAEM is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, National Association of EMS Physicians, North Carolina Medical Society, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Mark Zwanger, MD, MBA, Assistant Professor, Department of Emergency Medicine, Thomas Jefferson University
Mark Zwanger, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD, Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center
Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

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