Complications of pregnancy termination in Portugal: a national audit of reporting, 2015–2024

Pregnancy termination in Portugal is legally regulated to ensure safe, supervised access and to reduce maternal mortality associated with unsafe abortion. Monitoring of complications is mandatory but remains challenging, potentially undermining surveillance and quality of care. A retrospective national audit reviewed all semi-annual complication reports submitted by health units with gynaecology and obstetrics services between 2015 and 2024 under Norm 001/2013. Physical and electronic submissions were assessed using a structured checklist for completeness, timeliness and internal consistency. A supplementary survey explored reporting practices and data flows. Compliance was evaluated against a 75% threshold using descriptive statistics. Only 29 of 900 expected reports were received (3.2%), 62.1% from a single institution. A total of 369 events were recorded, mainly incomplete abortion (259; 69.4%), method failure (81; 22.0%) and endometritis (23; 6.2%). Most complications occurred in terminations up to 10 weeks (93.5%), with none reported in illegal cases. No maternal deaths were reported. National compliance with Norm 001/2013 was 39.4%. Mean submission delay was 110.9 days (range 3–434). The survey identified an 8.9% discrepancy between declared and actual practices, together with heterogeneous data flows and weak accountability. Mean data accuracy and quality scores were 58% and 56%, respectively. The audit exposed substantial underreporting and inconsistent recording of pregnancy termination complications in Portugal. This statistical invisibility compromises risk detection, quality assurance and clinical safety. A structured digital reporting system with automated validation, interoperability between information systems and periodic audits is urgently required to strengthen accountability and ensure transparent, reliable monitoring of pregnancy termination outcomes.

Key messages

• Mandatory reporting of pregnancy termination complications in Portugal is severely incomplete, limiting surveillance, quality assurance and timely detection of safety risks.

• Interoperable reporting systems and periodic audits are practical priorities for safer, more transparent monitoring of pregnancy termination care.