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Managing Complications of Procedural Abortion

Presented by Josephine Urbina, MD (she/her/ella)
University of California, San Francisco


  • Society of Family Planning, Management of Postabortion Hemorrhage, Contraception 2013
  • Society ofFamily Planning, Management of Postabortion Hemorrhage, Contraception 2013
  • Zane S, Creanga AA, Berg CJ, Pazol K, Suchdev DB, Jamieson DJ, Callaghan WM. Abortion-Related Mortality in the United States: 1998-2010. Obstet Gynecol. 2015 Aug;126(2):258-265. doi: 10.1097/AOG.0000000000000945. PMID: 26241413; PMCID: PMC4554338.
  • Peterson WF, Berry FN, Grace MR, Gulbranson CL. Second-trimester abortion by dilatation and evacuation: an analysis of 11,747 cases. Obstet Gynecol. 1983 Aug;62(2):185-90. PMID: 6866362.
  • Fox MC, Hayes JL; Society of Family Planning. Cervical preparation for second-trimester surgical abortion prior to 20 weeks of gestation. Contraception. 2007 Dec;76(6):486-95. doi: 10.1016/j.contraception.2007.09.004. Epub 2007 Nov 9. PMID: 18061709.
  • Diedrich J, Steinauer J. Complications of surgical abortion. Clin Obstet Gynecol. 2009 Jun;52(2):205-12. doi: 10.1097/GRF.0b013e3181a2b756. PMID: 19407527.
  • Bartlett LA, Berg CJ, Shulman HB, Zane SB, Green CA, Whitehead S, Atrash HK. Risk factors for legal induced abortion-related mortality in the United States. Obstet Gynecol. 2004 Apr;103(4):729-37. doi: 10.1097/01.AOG.0000116260.81570.60. PMID: 15051566.
  • Kerns JL, Ti A, Aksel S, Lederle L, Sokoloff A, Steinauer J. Disseminated Intravascular Coagulation and Hemorrhage After Dilation and Evacuation Abortion for Fetal Death. Obstet Gynecol. 2019 Oct;134(4):708-713. doi: 10.1097/AOG.0000000000003460. PMID: 31503145.
  • Kerns J, Steinauer J. Management of postabortion hemorrhage: release date November 2012 SFP Guideline #20131. Contraception. 2013 Mar;87(3):331-42. doi: 10.1016/j.contraception.2012.10.024. Epub 2012 Dec 4. PMID: 23218863.
  • Newmann S, Dalve-Endres A, Drey EA; Society of Family Planning. Clinical guidelines. Cervical preparation for surgical abortion from 20 to 24 weeks’ gestation. Contraception. 2008 Apr;77(4):308-14. doi: 10.1016/j.contraception.2008.01.004. Epub 2008 Mar 4. PMID: 18342657.
  • Shaw KA, Lerma K. Update on second-trimester surgical abortion. Curr Opin Obstet Gynecol. 2016 Dec;28(6):510-516. doi: 10.1097/GCO.0000000000000318. PMID: 27684047.
  • Shaw KA, Lerma K, Shaw JG, Scrivner KJ, Hugin M, Hopkins FW, Blumenthal PD. Preoperative effects of mifepristone for dilation and evacuation after 19 weeks of gestation: a randomised controlled trial. BJOG. 2017 Dec;124(13):1973-1981. doi: 10.1111/1471-0528.14900. Epub 2017 Sep 27. PMID: 28834186.
  • Borgatta L, Roncari D, Sonalkar S, Mark A, Hou MY, Finneseth M, Vragovic O. Mifepristone vs. osmotic dilator insertion for cervical preparation prior to surgical abortion at 14-16 weeks: a randomized trial. Contraception. 2012 Nov;86(5):567-71. doi: 10.1016/j.contraception.2012.05.002. Epub 2012 Jun 6. PMID: 22682721.
  • Darney PD, Sweet RL. Routine intraoperative ultrasonography for second trimester abortion reduces incidence of uterine perforation. J Ultrasound Med. 1989 Feb;8(2):71-5. doi: 10.7863/jum.1989.8.2.71. PMID: 2651693.
  • Pridmore BR, Chambers DG. Uterine perforation during surgical abortion: a review of diagnosis, management and prevention. Aust N Z J Obstet Gynaecol. 1999 Aug;39(3):349-53. doi: 10.1111/j.1479-828x.1999.tb03413.x. PMID: 10554950.
  • Sawaya GF, Grady D, Kerlikowske K, Grimes DA. Antibiotics at the time of induced abortion: the case for universal prophylaxis based on a meta-analysis. Obstet Gynecol. 1996 May;87(5 Pt 2):884-90. PMID: 8677129.
  • Whitehouse K, Tschann M, Soon R, Davis J, Micks E, Salcedo J, Savala M, Kaneshiro B. Effects of Prophylactic Oxytocin on Bleeding Outcomes in Women Undergoing Dilation and Evacuation: A Randomized Controlled Trial. Obstet Gynecol. 2019 Mar;133(3):484-491. doi: 10.1097/AOG.0000000000003104. Erratum in: Obstet Gynecol. 2019 Jun;133(6):1287-1288. PMID: 30741801.
  • Kerns JL, Pearlson G, Mengesha B, Harter K, Jackson RA, Drey EA. A randomized controlled trial of methylergonovine prophylaxis after dilation and evacuation abortion. Contraception. 2021 Feb;103(2):116-120. doi: 10.1016/j.contraception.2020.10.009. Epub 2020 Oct 17. PMID: 33075332.
  • Steinauer JE, Diedrich JT, Wilson MW, Darney PD, Vargas JE, Drey EA. Uterine artery embolization in postabortion hemorrhage. Obstet Gynecol. 2008 Apr;111(4):881-9. doi: 10.1097/AOG.0b013e3181685780. PMID: 18378747.