Effect of prior cesarean delivery on risk of second-trimester surgical abortion complications

To estimate second-trimester surgical abortion complication rates and to estimate the effect of past cesarean delivery on the risk of complications.

Demographic, medical, and operative data were collected prospectively between October 2004 and March 2007 in an academic, urban, U.S. abortion clinic. Complication and intervention rates were calculated. Multivariable logistic regression models were used to evaluate risk factors for a major complication, hemorrhage, cervical laceration, and atony.

We included 2,973 second-trimester surgical abortions. Cervical laceration (3.3%), atony (2.6%), and hemorrhage (1.0%) were the most common complications. The rate of major complications (eg, transfusion, disseminated intravascular coagulation, and reoperation) was 1.3%. In multivariable logistic regression modeling, a history of two or more cesarean deliveries was the strongest predictor for having a major complication (odds ratio [OR] 7.4, 95% confidence interval [CI] 3.4-15.8), while additional predictors included gestational age of 20 weeks or more (OR 4.4, 95% CI 2.0-11.4) and insufficient initial cervical preparation requiring further dilation (OR 2.6, 95% CI 1.2-5.4).

Second-trimester surgical abortions were associated with a major complication rate of approximately 1%. A history of two or more cesarean deliveries was associated with a sevenfold increase in odds of major complication and was the strongest independent risk factor for a major complication.

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