Abortion is one of the most common medical procedures for women aged 15 to 44 years in the United States (1,2). Each year, almost half of all pregnancies among American women are unintended, and about half of these unplanned pregnancies end in abortion. If current rates continue, it is estimated that 35% of all reproductive-age women in America will have had an abortion by the time they reach the age of 45 (3). In 2005, approximately 1.2 million abortions were performed in the United States, with nearly 90% performed in the first trimester (before 12 weeks) (3). Both medical and surgical abortions are low-risk procedures when performed early in gestation, and in a safe, legal setting. Fewer than 0.3% of abortion patients experience a complication that requires hospitalization (4). The risk of death from abortion is 1 in 100,000 or less while the risk of a woman dying from giving birth is 10 times higher (5,6,7).

Abortion has not always been so safe. Before its legalization in the United States in 1973, many women died or had serious complications following procedures by untrained practitioners with suboptimal techniques in unsanitary conditions or after attempts to self-induce abortion using knitting needles or wire coat hangers. These practices resulted in sepsis, thrombosis of the pelvic vasculature, disseminated intravascular coagulation (DIC), and death. In countries where abortion is still illegal, unsafe abortion remains a leading cause of maternal death (8).

Over 90% of surgical abortions are performed in outpatient settings, using either electric or manual (handheld syringe) vacuum aspiration (9). Perioperative antibiotics are routinely provided to patients. Women typically experience cramping and bleeding similar to a period for a few days to several weeks following the procedure. Regular menses usually returns in 4 to 6 weeks postprocedure.

In the United States, medical abortion is offered at gestational ages 9 weeks or less using 200 mg of oral mifepristone followed by 800 µg of misoprostol vaginally or buccally 6 to 48 hours later (10). Misoprostol-alone regimens have lower rates of successful complete abortion but are still utilized by some women to self-induce
abortion or in countries where mifepristone is not available (10). Patients are asked to return for an ultrasound approximately 2 weeks after their medical abortion to confirm that the procedure is complete. During the actual abortion, bleeding can be heavy and cramping may require narcotic analgesia. Both symptoms are expected to last for several hours while passing the pregnancy but usually improve within 24 hours (11). Nausea, vomiting, and diarrhea are known side effects of misoprostol and are also frequently reported (12). Symptoms of recovery following a medical abortion are similar to those with surgical abortion.

Although first trimester medical and surgical abortions are safe with low rates of major complications, these are common procedures, and therefore it is not unusual for women with abortion complications to present for emergent care. Physicians in such settings may encounter complications such as bleeding, infection, retained products of conception, continuing pregnancy, or ectopic pregnancy. Gynecologic consultation or referral is appropriate for these patients.