Pain during early abortion.

To determine which factors predict pain perception in women undergoing first-trimester abortion under local anesthesia.Women undergoing first-trimester abortion with local anesthesia were asked about their perception of pain during the procedure and at the time of discharge from the recovery room. They were also asked to compare the amount of pain experienced to their expected amount of pain. Additional data were abstracted from the patient record.During the study period, 1,055 women had abortions and had records suitable for analysis. Factors that were not found to be related to pain were the operating physician, maximal amount of cervical dilatation, size of the suction cannula, prior abortion and prior pelvic examination. Gestational age did not show a consistent relationship to pain, although there was a suggestion that pain perception increases at the highest gestational ages. Longer procedures and procedures following the use of osmotic dilators tended to have higher pain scores. Prior abdominal delivery did not have a significant relationship to pain score, but prior vaginal delivery correlated with decreased pain by any method of analysis. The difference in pain perception between women with and those without prior vaginal birth was most striking at the earliest gestational ages.Prior vaginal delivery was the most consistent predictor of decreased pain perception during first-trimester abortion. Future studies on discomfort during abortion should include gestational age, patient age and the route of prior deliveries.