Incidence of Emergency Department Visits and Complications After Abortion

Upadhyay, Ushma D. PhD, MPH; Desai, Sheila MPH; Zlidar, Vera MHS; Weitz, Tracy A. PhD, MPA; Grossman, Daniel MD; Anderson, Patricia MPH; Taylor, Diana PhD, RNP

doi: 10.1097/AOG.0000000000000603
Contents: Original Research

OBJECTIVE: To conduct a retrospective observational cohort study to estimate the abortion complication rate, including those diagnosed or treated at emergency departments (EDs).

METHODS: Using 2009–2010 abortion data among women covered by the fee-for-service California Medicaid program and all subsequent health care for 6 weeks after having an abortion, we analyzed reasons for ED visits and estimated the abortion-related complication rate and the adjusted relative risk. Complications were defined as receiving an abortion-related diagnosis or treatment at any source of care within 6 weeks after an abortion. Major complications were defined as requiring hospital admission, surgery, or blood transfusion.

RESULTS: A total of 54,911 abortions among 50,273 fee-for-service Medi-Cal beneficiaries were identified. Among all abortions, 1 of 16 (6.4%, n=3,531) was followed by an ED visit within 6 weeks but only 1 of 115 (0.87%, n=478) resulted in an ED visit for an abortion-related complication. Approximately 1 of 5,491 (0.03%, n=15) involved ambulance transfers to EDs on the day of the abortion. The major complication rate was 0.23% (n=126, 1/436): 0.31% (n=35) for medication abortion, 0.16% (n=57) for first-trimester aspiration abortion, and 0.41% (n=34) for second-trimester or later procedures. The total abortion-related complication rate including all sources of care including EDs and the original abortion facility was 2.1% (n=1,156): 5.2% (n=588) for medication abortion, 1.3% (n=438) for first-trimester aspiration abortion, and 1.5% (n=130) for second-trimester or later procedures.

CONCLUSION: Abortion complication rates are comparable to previously published rates even when ED visits are included and there is no loss to follow-up.

LEVEL OF EVIDENCE: II

After abortion, the incidence of any complication is 2.1% and the incidence of major complications is 0.23% in a closed system with data from all sources of care and complete follow-up.

Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California; John Snow, Inc, Arlington, Virginia; and Ibis Reproductive Health, Oakland, California. Ms. Zlidar is currently at the Public Health Institute, Washington, DC.

Corresponding author: Ushma D. Upadhyay, PhD, MPH, Assistant Professor, Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612; e-mail: Ushma.Upadhyay@ucsf.edu.

Supported by a University of California, San Francisco National Center of Excellence in Women's Health RAP Grant from Mount Zion Health Fund of the Jewish Community Endowment Fund and an anonymous foundation.

Presented at the North American Forum on Family Planning, October 6–7, 2013, Seattle, Washington.

The authors thank clinical consultants Kristina Ryan, RN, MSN, FNP, and Yvonne Piper, RN, FNP, MS, for their tireless efforts in coding the data; Diana Greene Foster, PhD, for providing expertise in Medi-Cal data analysis; Janley Hsiao, CPC, Billing Manager at San Francisco General Hospital, for providing expertise in Medi-Cal coding; Philip Darney, MD, MSc, for his critical review of the manuscript; and Shayna Lewis, JD, and Roula AbiSamra, MPH, for administration and coordination of the data.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2015 by The American College of Obstetricians and Gynecologists.