No, or minimal, increased risk of spontaneous abortion in future pregnancies after an abortion

Septic abortion if not done medically (Nejm 1994;331:310), but even then infection occurs in 1% (prophylactic tetracycline 500 mg po qid × 5 d decreases to 0.25%); uterine perforation; retained products of conception; POSTABORTAL SYNDROME: bleeding, in absence of retained tissue, which spontaneously resolves or is rx'd with Methergine

No incr in breast cancer risk (Nejm 1997;336:81; Jama 1996;275:283, 321)

Lab:Path:Confirm gestational tissue and r/o mole

Rx:

of 1st trimester pregnancy (Nejm 2000;342:946):

• Mifepristone (Mefeprex, RU-486) (Med Let 2000;42:101; Nejm 1993;329:404), an antiprogesterone, in 1st 2 mo of pregnancy, 200-600 mg po followed in 1.5-2 d with misoprostol (Cytotec) 400 µgm po (Nejm 1998;338:1241) or 800 µgm vaginally (Jama 2000;284:1948; Nejm 1995;332:983); causes 95+% to abort completely (Nejm 1998;338:1241; 1993;328:1509; 1990;322:645; Med Let 1990;32:112); adv effects: Möbius syndrome(facial paralysis and limb defects) if fail to abort (Nejm 1998;338:1881); cost: $100/200 mg
• Suction evacuation, or
• Misoprostol (Cytotec) (Nejm 2001;344:38, 59) 200 µgm vag q 12 h; a prostaglandin that causes 90% to abort within 2 d; 55% need subsequent D&E; adverse effects: fever (11%), abdominal pain (57%), emesis (4%), diarrhea (4%); cost $1; or
• Methotrexate 50 mg/m² im, followed in 3-7 d by misoprostol 800 µgm vag × 1 and repeated in 1-7 d if no abortion; 90+% complete abortions, 4-9% require vacuum extraction w or w/o dilatation (Med Let 1996;38:39; Nejm 1995;333:537; Jama 1994;272:1190)
• Epostane (prevents progesterone synthesis) 200 mg qid × 7 d at 5-8 wk causes 84% to abort within 2 wk, usually at 5 d (Nejm 1988;319:813)

of 2nd trimester pregnancy:

• Prostaglandin E₂ (Nejm 1994;331:290) 20 µgm vaginally q 3 h; aborts 80% within 2 d, 70% will need a D&C as well; adverse effects: fever (63%), pain (67%) and abdominal cramping, emesis (33%), diarrhea (30%); $300 cost
• D&E up to 18+ wk