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By Prof F E. Okonofua . Provost College of Medical Sciences University of Benin
Abortion is the loss of pregnancy before it has reached stability
Two types: Spontaneous Induced
Estimates of Abortion
Spontaneous Abortion – Estimates are unknown, because many are non-clinical abortions 500,000 18,400,000 19 million 4.2 million 610,000
Induced Abortion Developed Countries Developing Countries Total (World) Africa Nigeria 3.
Impact of induced Abortion
deaths Number of maternal deaths From Abortion World 67,900 Developed countries 300 Developing Countries 67,500 Africa 29,800 Nigeria *20,000 40* 13 14 13 12 % of all maternal
Clinical Aspects of Spontaneous Abortion
(including belighted ovum and missed abortion)
Mild to moderate vaginal bleeding Uneffaced and undilated cervix No abdominal pain Fetus often viable Conservative management
Blighted ovum Severe effacement and dilatation of the cervix, with or without passage of products of conception Death and retention of the fetus between 12 and 28 weeks (missed abortion)
Treatment of Inevitable Abortion
D&C versus MVA
2. Misoprostol all stages, including blighted ovum
4. 5. 6.
Cervical Incompetence Maternal illnesses – hypo or hyperthyroidism diabetes mellitus, cardiovascular diseases Materno-fetal infections (toxoplasmosis, Listeria monocytogene, rubella, cytomegalovirus, herpes simplex virus, brucella, Chlamydia, ureaplasma urealyticum, T-strain mycoplasma) Endocrine factors – polycystic ovarian disease, luteal phase defect Chromosomal anomalies Immunological incompatibility
Aetiology of Recurrent Abortion
Investigation of Recurrent Abortion
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.
Detailed History and physical examination Hormone Assay Thyroid, renal & liver function tests Glucose tolerance tests HSG Ultrasound scan SLE Lupus anti-coagulant test Anti-cardiolipin antibodies Anti-nuclear factor Anti-thyroid antibodies Blood grouping HLA typing in both partners
Treatment of Recurrent Abortion
Treatment of underlying medical conditions Progesterone vaginal pressaries Myomectomy Cervical cerclage Lash & Lash procedure Shirodkar’s technique MacDonald's technique
Induced Abortion is done in all societies and in all cultures The issues is whether it is safe or unsafe Induced abortion tends to be safe in countries where abortion is legal and unsafe in countries where abortion is restrictive and legal Abortion tends to be safe in developed countries and unsafe in developing countries
Patterns of Abortion Law in Africa Countries
2. 4. 5. 6.
Abortion to save life of pregnant woman only Abortion to preserve the life or health of a woman 9 To save her life and in cases of rape 2 To preserve her life or health in cases of contraceptive failure 1 In cases of pregnancy resulting from rape and incest – and fetal defect & to preserve her life & health 9 Additional indication of socioeconomic hardship (Zambia) Additional indication of a woman who is too young or mentally unable to care for a child (Ethiopia) 1 On request (Cape Verde, South Africa & Tunisia)
No of Countries 24
Why Women have Unwanted Pregnancy and Seek Abortion
They are too young or want postpone child bearing They want no more children They cannot afford to raise a child They are unmarried or still in school Their partners does not want the pregnancy or there is a problem with relationship They become pregnant due to rape or incest
Determinants of unwanted Pregnancy and Unsafe Abortion
Young maternal age The role of women education Pattern of contraceptive use Religion Abortion laws Provider attitude and training Use of outdated abortion methods and technology Economic and geographic inequality
Complications of Induced Abortion
Immediate Occurring during or within 48 hours Late Occurring later, especially after 48 hours
Early Complications of Induced Abortion
Haemorrhage Damage to adjacent organs – perforated uterus Sepsis (Septic abortion) Gram negative septicaemia
Treatment of Early Complications of Induced Abortion
1. 2. 3.
Intravenous infusion and/or blood transfusion Blood spectrum antibiotics Evacuation of retained products of conception (MVA) Laparotomy
Late complications of induced Abortion
1. 2. 3. 4.
Chronic pelvic inflammatory disease Ectopic pregnancy Cervical Incompetence Asherman syndrome
Regimen for Safe Practice of Abortion
1st seven weeks Mifepristone – misoprostol Misoprosotol alone MVA D&C 8 – 14 weeks Misoprostol – MVA Misoprostol – D & C After 14 weeks Mifepristone – misoprostol Repeated doses of misoprostol
Different Perspectives of Abortion
Abortion Abortion Abortion
a public health issue a gender issue a rights issue right to life right to health, reproductive health and family planning right to be free from discrimination right to liberty & security of persons right to scientific progress a social and economic justice
Prevention of Unsafe Abortion Primary Prevention
- sexuality education - promotion of contraception Secondary Prevention - provision of counseling to women with unwanted pregnancies - Liberation of abortion laws - Increasing women’s access to safe abortion services Tertiary Prevention - Post abortion Care (PAC) at all levels - In-services and pre-service training of providers - Decentralization of PAC