Editing Abortion (section)

=== Safety and gestational age===
[[Vacuum aspiration]] in the first trimester is the safest method of surgical abortion, and can be performed in a [[primary care|primary care office]], [[abortion clinic]], or hospital. Complications, which are rare, can include [[uterine perforation]], [[endometritis|pelvic infection]], and retained products of conception requiring a second procedure to evacuate.<ref name="arch-fam-practice">{{cite journal | vauthors = Westfall JM, Sophocles A, Burggraf H, Ellis S | title = Manual vacuum aspiration for first-trimester abortion | journal = Archives of Family Medicine | volume = 7 | issue = 6 | pages = 559–562 | year = 1998 | pmid = 9821831 | doi = 10.1001/archfami.7.6.559 | url = http://archfami.ama-assn.org/cgi/content/full/7/6/559 | url-status = dead | archive-url = https://web.archive.org/web/20050405202853/http://archfami.ama-assn.org/cgi/content/full/7/6/559 | archive-date = 5 April 2005 | url-access = subscription }}</ref> Infections account for one-third of abortion-related deaths in the United States.<ref>{{cite journal | vauthors = Dempsey A | title = Serious infection associated with induced abortion in the United States | journal = Clinical Obstetrics and Gynecology | volume = 55 | issue = 4 | pages = 888–892 | date = December 2012 | pmid = 23090457 | doi = 10.1097/GRF.0b013e31826fd8f8 }}</ref> The rate of complications of vacuum aspiration abortion in the first trimester is similar regardless of whether the procedure is performed in a hospital, surgical center, or office.<ref>{{cite journal | vauthors = White K, Carroll E, Grossman D | title = Complications from first-trimester aspiration abortion: a systematic review of the literature | journal = Contraception | volume = 92 | issue = 5 | pages = 422–438 | date = November 2015 | pmid = 26238336 | doi = 10.1016/j.contraception.2015.07.013 }}</ref> Preventive antibiotics (such as [[doxycycline]] or [[metronidazole]]) are typically given before abortion procedures,<ref>{{cite journal | vauthors =  | title = ACOG practice bulletin No. 104: antibiotic prophylaxis for gynecologic procedures | journal = Obstetrics and Gynecology | volume = 113 | issue = 5 | pages = 1180–1189 | date = May 2009 | pmid = 19384149 | doi = 10.1097/AOG.0b013e3181a6d011 | doi-access =  }}</ref> as they are believed to substantially reduce the risk of postoperative uterine infection;<ref name="NEJMDec2011" /><ref>{{cite journal | vauthors = Sawaya GF, Grady D, Kerlikowske K, Grimes DA | title = Antibiotics at the time of induced abortion: the case for universal prophylaxis based on a meta-analysis | journal = Obstetrics and Gynecology | volume = 87 | issue = 5 Pt 2 | pages = 884–890 | date = May 1996 | pmid = 8677129 }}</ref> however, antibiotics are not routinely given with abortion pills.<ref>{{cite journal | vauthors = Achilles SL, Reeves MF | title = Prevention of infection after induced abortion: release date October 2010: SFP guideline 20102 | journal = Contraception | volume = 83 | issue = 4 | pages = 295–309 | date = April 2011 | pmid = 21397086 | doi = 10.1016/j.contraception.2010.11.006 | doi-access = free }}</ref> The rate of failed procedures does not appear to vary significantly depending on whether the abortion is performed by a doctor or a [[mid-level practitioner]].<ref>{{cite journal | vauthors = Barnard S, Kim C, Park MH, Ngo TD | title = Doctors or mid-level providers for abortion | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 7 | pages = CD011242 | date = July 2015 | pmid = 26214844 | doi = 10.1002/14651858.CD011242.pub2 | pmc = 9188302 | url = https://researchonline.lshtm.ac.uk/2274695/1/Doctors%20or%20mid-level%20providers%20for%20abortion_GREEN%20VoR.pdf | access-date = 24 November 2019 | archive-date = 27 August 2021 | archive-url = https://web.archive.org/web/20210827202229/https://researchonline.lshtm.ac.uk/id/eprint/2274695/1/Doctors | url-status = live }}</ref>

Complications after second trimester abortion are similar to those after first trimester abortion, and depend somewhat on the method chosen.<ref>{{cite journal | vauthors = Lerma K, Shaw KA | title = Update on second trimester medical abortion | journal = Current Opinion in Obstetrics & Gynecology | volume = 29 | issue = 6 | pages = 413–418 | date = December 2017 | pmid = 28922193 | doi = 10.1097/GCO.0000000000000409 | quote = Second trimester surgical abortion is well tolerated and increasingly expeditious | s2cid = 12459747 }}</ref> The risk of death from abortion approaches roughly half the risk of death from childbirth the farther along a woman is in pregnancy; from one in a million before 9 weeks gestation to nearly one in ten thousand at 21 weeks or more (as measured from the last menstrual period).<ref>{{cite journal | collaboration = Committee on Practice Bulletins-Gynecology | vauthors = Steinauer J, Jackson A, Grossman D |title=Second-trimester abortion. Practice Bulletin No. 135. |journal=American College of Obstetrics & Gynecology - Practice Bulletins |date=June 2013 |url=https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Bulletins/Committee-on-Practice-Bulletins-Gynecology/Second-Trimester-Abortion |access-date=4 December 2019 |quote=The mortality rate associated with abortion is low (0.6 per 100,000 legal, induced abortions), and the risk of death associated with childbirth is approximately 14 times higher than that with abortion. Abortion-related mortality increases with each week of gestation, with a rate of 0.1 per 100,000 procedures at 8 weeks of gestation or less, and 8.9 per 100,000 procedures at 21 weeks of gestation or greater. |archive-date=24 December 2019 |archive-url=https://web.archive.org/web/20191224111109/https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Bulletins/Committee-on-Practice-Bulletins-Gynecology/Second-Trimester-Abortion |url-status=live }}</ref><ref name=Bartlett2004>{{cite journal | vauthors = Bartlett LA, Berg CJ, Shulman HB, Zane SB, Green CA, Whitehead S, Atrash HK | title = Risk factors for legal induced abortion-related mortality in the United States | journal = Obstetrics and Gynecology | volume = 103 | issue = 4 | pages = 729–737 | date = April 2004 | pmid = 15051566 | doi = 10.1097/01.AOG.0000116260.81570.60 | quote = The risk factor that continues to be most strongly associated with mortality from legal abortion is gestational age at the time of the abortion | s2cid = 42597014 | doi-access = free }}</ref> It appears that having had a prior surgical uterine evacuation (whether because of induced abortion or treatment of miscarriage) correlates with a small increase in the risk of preterm birth in future pregnancies. The studies supporting this did not control for factors not related to abortion or miscarriage, and hence the causes of this correlation have not been determined, although multiple possibilities have been suggested.<ref name=Saccone2016>{{cite journal | vauthors = Saccone G, Perriera L, Berghella V | title = Prior uterine evacuation of pregnancy as independent risk factor for preterm birth: a systematic review and metaanalysis | journal = American Journal of Obstetrics and Gynecology | volume = 214 | issue = 5 | pages = 572–591 | date = May 2016 | pmid = 26743506 | doi = 10.1016/j.ajog.2015.12.044 | url = https://www.iris.unina.it/retrieve/handle/11588/697884/158333/25%20Abortion%20PTB%20-%20AJOG%20-%20SACCONE.pdf | access-date = 27 June 2020 | url-status = live | quote = Prior surgical uterine evacuation for either I-TOP[induced termination of pregnancy] or SAB[spontaneous abortion, - also known as miscarriage] is an independent risk factor for PTB[pre-term birth]. These data warrant caution in the use of surgical uterine evacuation and should encourage safer surgical techniques as well as medical methods. | archive-url = https://web.archive.org/web/20210827202228/https://www.iris.unina.it/retrieve/handle/11588/697884/158333/25%20Abortion%20PTB%20-%20AJOG%20-%20SACCONE.pdf | archive-date = 27 August 2021 }}</ref><ref>{{cite journal | vauthors = Averbach SH, Seidman D, Steinauer J, Darney P | title = Re: Prior uterine evacuation of pregnancy as independent risk factor for preterm birth: a systematic review and metaanalysis | journal = American Journal of Obstetrics and Gynecology | volume = 216 | issue = 1 | page = 87 | date = January 2017 | pmid = 27596618 | doi = 10.1016/j.ajog.2016.08.038 | url = https://www.ajog.org/article/S0002-9378(16)30650-0/fulltext | access-date = 28 June 2020 | url-status = live | archive-url = https://web.archive.org/web/20210827202230/https://www.ajog.org/article/S0002-9378%2816%2930650-0/fulltext | archive-date = 27 August 2021 | doi-access =  | url-access = subscription }}</ref>