FACTORS ASSOCIATED WITH IMMEDIATE ABORTION COMPLICATIONS

Objective: To identify factors associated with increased risk of immed iate complications from induced abortion. Design: Retrospective analys is of a provincial database. Setting: All Ontario general hospitals in which abortions are performed and all free-standing abortion clinics in Ontario. Population: Women in Ontario aged 15 to 44 years who under went an induced abortion in the province (without concurrent steriliza tion) between Jan. 1, 1992, and Dec. 31, 1993. Outcome measures: Recor ding of complications at the time of the procedure, gestational age, t ype of procedure, place of abortion (hospital or clinic), and patient' s age, parity and history of previous abortion (spontaneous or induced ). Results: During the study period 83 469 abortions were performed th at met our inclusion criteria. Immediate complications were reported i n 571 cases (0.7%). Multivariate logistic regression analysis revealed that, after other variables were controlled for, the patient's age, p arity and history of previous abortions (spontaneous or induced) were not significant risk factors for immediate complications, however, ges tational age, method of abortion and place of abortion were significan t risk Factors (p < 0.001). The odds ratio (OR) for having a complicat ion from abortion was 1.3 (95% confidence interval [CI] 1.02 to 1.63) between 9 and 12 weeks, compared with having one after abortion at 9 w eeks or earlier, and increased to 3.3 (95% CI 2.23 to 5.00) after abor tion beteen 17 and 20 weeks. Compared with surgical dilatation and cur ettage (D&C), instillation of saline and instillation of prostaglandin s were more likely to be associated with immediate complications (OR 2 4.0, 95% CI 13.22 to 43.70, and OR 11.7, 95% CI 6.43 to 21.18, respect ively), whereas both suction D&C and insertion of a laminaria tent wer e less likely to be associated with immediate complications (OR 0.4, 9 5% CI 0.26 to 0.67, and OR 0.3, 95% CI 0.19 to 0.52, respectively). Co mpared with women who had an abortion in a free-standing clinic, the r isk for immediate complications was greater among those who had an abo rtion in a hospital, especially a teaching hospital (OR 1.9, 95% CI 1. 38 to 2.58), a nonteaching hospital with 200 to 399 acute care beds (O R 3.1, 95% CI 2.27 to 4.21) and a nonteaching hospital with fewer than 200 acute care beds (OR 5.9, 95% CI 4.04 to 8.64). Conclusion: The ri sk of immediate complications from induced abortion is very low. Unlik e in previous studies, the woman's age, parity and history of previous spontaneous or induced abortions were not found to be risk factors. H owever, advancing gestational age and procedures involving instillatio n of saline or prostaglandins were predictive factors of immediate com plications.