Hysterectomy as treatment for complications of legal abortion.

The frequency of hysterectomy as treatment for abortion complications may reflect the incidence of serious abortion morbidity. To examine this use of hysterectomy, the authors analyzed reports of approximately 237,000 legal abortions performed in the United States from 1970 to 1978. Overall, the rate of hysterectomy associated with curettage abortion decreased from 4.6 per 10,000 abortions in 1970 to 1971 to 1.4 per 10,000 in 1975 to 1978; the rate of hysterectomy associated with instillation abortion fell from 6.8 to 4.3 per 10,000 for the same years. A history of older age, previous births, use of instillation abortion, and preexisting gynecologic disorders increased the likelihood of hysterectomy. In cases of curettage abortion, hysterectomy rates increased significantly with advancing gestational age. Changes in abortion technology, improvements in physician skill, and more conservative management of complications have likely contributed to the decreasing frequency of hysterectomy necessitated by abortion complications.