Two cases of adolescent females attempting self-induced abortions are presented. Many ramifications and complications of illegal abortions are discussed as they affect the patient and society. In addition, we discuss the future of medical education as well as the economic aspects of health care in relationship to illegal abortions.
PIP: Two case studies are presented which show the damaging effects of self-induced abortion. Both cases involved adolescents who were recently treated in the Emergency Medical Department of the University of Colorado Hospital. Case I involved a 16-year-old indigent girl who arrived with vaginal bleeding and abdominal pain. The self-induced abortion had been attempted with a coat hanger inserted into the cervical os some time in the 3 days before admission to the hospital. The reason for the attempt was lack of money for a therapeutic abortion. The patient presented with a blood pressure of 110/70 tore, pulse of 80 beats/min, respiration of 20 breaths/min, and temperature of 37.5 degrees Centigrade. Pelvic examination revealed muco-purulent drainage with marked cervical and bilateral adnexal tenderness. Laboratory white cell count was 6400 mm, hematocrit was 40.7, and a beta subunit human chorionic gonadotropin pregnancy test was negative. The patient may indeed not have been pregnant. Treatment involved administration of 250 mg ceftriaxone intramuscularly and oral doxycycline for pelvic inflammatory disease. The recovery was uneventful. Case II involved a 17-year-old female who had run into walls, hit herself in the abdomen, and bathed in vinegar and water. Her vital signs were good, physical examination revealed a well-nourished, well-developed gravid female in no acute distress. She was referred to Planned Parenthood, psychiatric counseling, and told to return if pains developed. She had the therapeutic abortion which she thought she could not afford. Of the 6 million pregnancies in the US, 56.5% are unintended. Figures on attempted self-induced abortion are unknown. These 2 cases of low income adolescents draw attention to issues that have not been addressed in medical literature in 15 years. A brief summary is provided on abortion availability and the history of self-induced abortion methods. Discussion is also directed to morbidity and mortality trends, the psychologic impact on the mother, the fiscal impact of illegal abortions and their complications, and future prospects in the US. Concern is raised that restrictive legislation on abortions will lead to increases in unwanted pregnancies and illegal abortions with their inevitable complications. These issues place emergency medicine and physicians in the center of the policy debate.