PE Risk after Induced Abortion


    PE Risk after Induced Abortion

    It’s well known that the risk of venous thromboembolism is increased during pregnancy.  It is thought to be two-to-six times higher than the risk in non-pregnant women.  However, these risk estimates are based on pregnant populations that go on to deliver a baby.  Last year Ray et al. published a paper describing their findings on the unique risk of venous thromboembolism that exists after induced abortion.

    The investigators identified 176,000 primigravid women whose first pregnancy ended in induced abortion and matched them with other women whose first pregnancy ended in delivery.  They were also matched with non-pregnant controls.  The primary outcome was any VTE within 42 days of abortion or delivery.  They found that the risk was 30.1 per 100,000 after induced abortion, 184 per 100,000 after delivery, and 13.5 per 100,000 in the non pregnant group.  In other words, induced abortion carries double the risk than that of non-pregnancy, but remains significantly lower than after a livebirth.

    The risk of PE was 21 per 100,000 in the abortion group, and 125 in the livebirth group.  There was no measurement or report of mortality in this study.  However, we can look to the work by Greise et al. in 1978 which suggested that fatal PE is thought to occur in at least 1 out of every 350,000 women undergoing legal abortion (NOTE: this figure says nothing about temporality).

    The implications of these findings are rather significant given that an estimated 25% of pregnancies worldwide end in abortion.


    Liu N, Vigod SN, Farrugia MM, Urquia ML, Ray JG. Venous thromboembolism after induced abortion: a population-based, propensity-score-matched cohort study in Canada. Lancet Haematol. 2018;5(7):e279-e288.

    Greiss FC Jr: Deaths caused by pulmonary thromboembolism after legally induced abortion. Discussion. Am J Obstet Gynecol 132:173, 1978

    • Welcome! This is the website for the Mount Sinai Emergency Ultrasound Division. It serves as an information resource for residents, fellows, medical students and others seeking information about point-of-care ultrasound. There is a lot ofRead more

    • renal handling of water

      If you were on a tea & toast diet, how much water would you need to drink before you develop hyponatremia? I haven’t seen anyone work out the numbers before so here are my calculations. AndRead more

    • acute acidemia physiology

      As alluded to in the first post, don’t be fooled by a “normal” potassium in the setting of DKA because osmotic diuresis and H+/K+ exchange means that total body potassium is actually LOW. You all knowRead more

    • renal handling of potassium

      the first symptom of hyperkalemia is death Earlier post covered temporizing measures to counter hyperkalemia — namely, intracellular shift, increasing cardiac myocyte threshold potential. Give furosemide if the patient still urinates and consider dialysis, but then askRead more

    • bicarbonate revisited

      Previous post reviewed the safety of balanced crystalloids in hyper K. But what was up with serum bicarbonate decreasing with saline administration? This post introduces a new way of looking at the anion gap to possiblyRead more

    • hyperkalemia and balanced crystalloids

      Is it safe to give LR or plasmalyte to a hyperkalemic patient (these balanced crystalloids have 4-5 mEq/L K as opposed to 0 mEq/L K in normal saline)? Postponing the discussion of renal handling of potassium toRead more

    • hyperkalemia physiology

      You’ll likely encounter hyperkalemia on your next Resus / Cardiac shift, and you’ll instinctively treat it. But take a moment to review the fascinating physiology behind the “cocktail”! First, consider how K+ is buffered byRead more

    • Slow down your tachycardia (but not really)

      You’re sitting in resus bemoaning the departure of your most beloved attending when suddenly a patient wheels in without warning. The patient looks relatively stable but the triage RN tells you her heart rate wasRead more

    • Otitis externa: use the ear wick!

      Acute otitis externa (AOE) is a common complaint seen in pediatric as well as adult emergency departments. AOE is typically not accompanied by acute otitis media, although concurrent cases are possible. Also called “swimmer’s ear”Read more