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Factors associated withcomplications followingprovoked abortionRolando Armijo & Tegualda MonrealPublished online: 11 Jan 2010.

To cite this article: Rolando Armijo & Tegualda Monreal (1968) Factorsassociated with complications following provoked abortion, The Journal of SexResearch, 4:1, 1-6, DOI: 10.1080/00224496809550551

To link to this article: http://dx.doi.org/10.1080/00224496809550551

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The Journal of Sex Research Vol. 4, No. 1, pp. 1-6 February, 1968

Factors Associated With ComplicationsFollowing Provoked Abortion

ROLANDO ARMIJO AND TEGUALDA MONREAL*

Post-operative complications, so frequently associated with pro-voked abortion, have aroused public attention and concern in Chile.This paper is the second based on an investigation started in 1961to provide better knowledge of the factors associated with provokedabortion (Armijo and Monreal, 1966).

The study is based on data obtained from a random sample of1,890 women of reproductive age in Greater Santiago, interviewed in1962. A total of 496 women were found to have had a history ofprovoked abortion; they had experienced 1,394 abortions, or 2.8abortions per woman. Excluding 72 abortions for which data on hos-pitalization were not available, a total of 1,322 provoked abortionsremained for analysis, of which 31.5 per cent had required hospitali-zation.

The question then arises: Avhat were the factors associated withthe need for hospital care which might be considered indicators forcomplications? In an attempt to answer this question, this paper re-lates the risk of complications, as expressed in terms of hospital ad-mission, to such factors as the age of the woman at the time of abor-tion, the order of the interrupted pregnancy, the number of previousabortions, the month of gestation, the type of person inducing theabortion, and the method used.

The age distribution of all women having induced abortions andthe number and per cent of those hopsitalized, by age group, areshown under A of Table 1. The rate of hospital admissions of womenyounger than 30 years at time of abortion is approximately equal tothat of older women. In fact, the proportion hospitalized differs byonly a few percentage points between the 5-year age groups fromunder 19 years to 35 years and older. It can therefore be concludedthat age at time of abortion does not seem to be a factor as far as post-abortion complications are concerned.

A relationship between pregnancy order and the risk of complica-

* The authors wish to thank Miss Sarah Lewit for her editorial assistance.

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ROLANDO ARMIJO AND TEGUALDA MONREAL

TABLE 1Characteristics of Women Hospitalized Following Provoked Abortion:

Number and Per Cent

Characteristic

Total

A. AgeUnder 1920-2425-2930-3435 and overNot stated

B. Pregnancy order1-34-67-910 and overNot stated

C. Abortion order1234-67-910 and over

D. Month of gestation123-5Not stated

E. OperatorDoctorMidwifeAmateurSelf-operatorNot stated

F. MethodCurettageDrugsCatheterOtherNot stated

Number of provoked abortions

Total

1,322

91365418271

8790

35345722919390

45727317325710854

350580306

86

138595338137114

5041195815563

Admitted to hospital

417

30105140962422

98152896018

1529565682611

6318214428

351191497242

9641

2432017

Per cent hospitalized of total

31.5

33.028.833,535.427.6

*

27.833.338.931.1

*

33.334.837.626.524.120.4

18.031.447.1

*

25.420.044.152.6

*

19.034.541.836.4

*

' Not computed.

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COMPLICATIONS FOLLOWING PROVOKED ABORTION 3

tion is suggested by the data under B of Table 1. The proportion ofwomen hospitalized rises steadily between the first-third pregnancyorders (27.8 per cent hospitalized) and the seventh-ninth pregnancyorders (38.9 per cent hospitalized). The decline in the proportionfrom the tenth pregnancy and more may be due to selection ofwomen who have had abortions without suffering any permanentdamage and have therefore reached higher pregnancy orders.

A distribution of abortions by order, under C, indicates an in-verse association between the risk of complications or hospitalizationand the order of the abortion. Abortions of lower order—and notthose of higher order as might be expected—appear to carry thegreater risk. From the first to the third induced abortion, the pro-portion hospitalized rises somewhat—from 33.3 per cent to 37.6 percent; while from the fourth to the tenth abortion and over, it dropsfrom 26.5 per cent to 20.4 per cent. However, it should be pointedout that the smaller risk which follows abortions of the fourth andhigher orders may be due to the selection of women who, havingundergone numerous abortions, continue the practice precisely be-cause they had had no complications previously.

Examination of the data under D of Table 1 shows a direct rela-tionship between the month of gestation and the risk of complica-tions. Abortions carried out during the first month of gestation hada probability of complications of one case out of five. By the thirdmonth, the probability increased to almost one out of two.

The person inducing the abortion appears to have a direct re-sponsibility for the risk of complication. The graduate midwife andthe doctor have the lowest rates (20.0 per cent and 25.4 per cent,respectively). In the case of the amateur abortionist, the risk risesto 44.1 per cent and reaches its maximum (52.6 per cent) when theabortion is performed by the woman herself. The difference in thelevel of risk between the doctor and the qualified midwife is notsignificant.

When abortions are cross-tabulated by month of gestation and byoperator, the relationship between the risk of complication and thelatter two factors is emphasized (Table 2). The least risk for all pe-riods of gestation is found when the doctor and the qualified mid-wife are the operators. Although starting with the third month ofpregnancy, the risk with the doctor performing the operation is onlyslightly higher than during the first two months, the number of

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ROLANDO ARMIJO AND TEGUALDA MONREAL

TABLE 2

Provoked Abortions by Month of Gestation and Operators :Number and Per Cent Hospitalized

Operator

TotalHospitalized

NumberPer cent

DoctorHospitalized

NumberPer cent

Graduate midwifeHospitalized

NumberPer cent

AmateurHospitalized

NumberPer cent

Self-operatorHospitalized

NumberPer cent

1st

350

6318.058

1017.2

174

2011.547

1531.944

920.5

2nd

580

18231.443

1125.6

294

5217.7

137

6245.356

3562.5

3rd and over

306

14447.132

928.1

113

4136.3

124

7056.522

13-59.1

Not stated

86

28

5

5*

14-

6

30

2

15

15—

Total

1,322

41731.5

138

3525.4

595

11920.0

338

14944.1

137

7252.6

* Not computed.

cases involved is too small for reliable conclusions. In all othercategories of operators, including the midwife, the risk rises sharplystarting with the third month. For women in the third and latermonths of pregnancy the chances of hospitalization following an in-duced abortion by an amateur abortionist and by the self-operatorrise to nearly three out of five.

Of the methods used for provoking abortion, curettage by instru-ment carries the least risk of complications (19.0 per cent), as shownunder F of Table 1. Drugs, douches, and "other" methods carry ahigher risk (approximately 35.0 per cent), and the catheter or rub-ber tube, the highest risk (41.8 per cent).

Curettage is almost the only method used by physicians in per-forming abortions and is the method most frequently used by thequalified midwife (Table 3). It is used infrequently by the amateurabortionist, in whose hands it carries a risk of complication of 45.2per cent, compared with 23.2 per cent for the doctor and 11.8 per

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COMPLICATIONS FOLLOWING PROVOKED ABORTION 5

TABLE 3Provoked Abortions by Method and Operator: Number and Per Cent Hospitalized

Operator

TotalHospitalized

NumberPer cent

DoctorHospitalized

NumberPer cent

Graduate midwifeHospitalized

NumberPer cent

AmateurHospitalized

NumberPer cent

Self-operatorHospitalized

NumberPer cent

Curettage

504

9619.0

125

2923.2

321

3811.842

1945.2—

——

Method of provoking abortion

Drugs

119

4134.52

1*

17

529.435

1028.632

1340.6

Catheter

581

24341.8

6

3*

246

7630.9

248

11446.069

4666.7

Other

55

2036.4—

——8

——

11

6*

25

1144.0

Not stated

63

17*5

2*3

——

2

——11

2*

Total

1,322

41731.5

138

3525.4

595

11920.0

338

14944.1

137

7252.6

* Not computed.

cent for the graduate midwife. Curettage is never used by the self-operator.

The catheter or rubber tube is most frequently used by the ama-teur abortionist and by the woman operating on herself. The cathe-ter is used by the midwife in about two-fifths of her cases, with anaccompanying risk of complication of 30.9 per cent, compared with46.0 per cent for the amateur abortionist and 66.7 per cent for theself-operator.

SUMMARY

Information obtained from a random sample of 1,890 women in-terviewed in Santiago in 1962 is analyzed.

Data on 1,322 cases of provoked abortions show that 31.5 per centrequired hospitalization. On the assumption that admission to ahospital is indicative of complications, associated factors were stud-ied.

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6 ROLANDO ARMIJO AND TEGUALDA MONREAL

It was found that the age of the woman apparently bore no rela-tionship to the risk of complication, while parity seemed to have adirect relationship, with the proportion hospitalized increasing withpregnancy order. At the same time, the number of abortions had aninverse relationship to risk, which decreased sharply starting withthe fourth abortion. However, it is possible that women with pre-viously successful abortions may account for the reduced risk inabortions of higher order.

A strong relationship was found between month of gestation, thecategory of person performing the operation, and the type of opera-tion. The risk of complications increased rapidly by the third monthof gestation. In all months of gestation, however, operations per-formed by physicians and the qualified midwives carried the leastrisk, compared with amateur abortionists and women who them-selves induced abortion. Of the methods used, curettage carried theleast risk. The risk of complication rose sharply with the use of thecatheter, the method most favored by amateur abortionists and bywomen operating on themselves.

References

ARMIJO, R. AND MONREAL, T. Epidemiology of Provoked Abortions in Santiago, Chile.Journal of Sex Research, 1:143-159, 1966.

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