Abortions and Post Abortion Care

2. INTRODUCTION/DEFINITION
INCIDENCE
CLASSIFICATION OF ABORTION
AETIOLOGY OF SPONTANEOUS ABORTION
CLINICAL FEATURES/TYPES
COMPLICATIONS
UNSAFE ABORTION
POST ABORTION CARE
PREVENTION OF UNSAFE ABORTION
CONCLUSION

3. Termination or loss of pregnancy before the
age of viability( 28, 24 , 22 wks or <500 g)
WHO-24 wks or 500 g
In our environment- Officially still 28 wks
UK- 24 wks
USA-22 wks

4. Abortion is a significant public health
problem and an important cause of maternal
mortality in the developing world
 An estimated 70,000 women die from
complications of induced abortion annually in
the world
 A large number of these deaths (over 99%)
are due to unsafe procedures carried out in
developing countries
 Preventing maternal deaths is an important
Millennium Development Goal

5. -Varies
10-20%, or 15% of clinically recognized
pregnancies
Over half of all pregnancies lost
spontaneously

6. women may abort before knowing they are
pregnant
-delayed menses may be diagnosed as
pregnancy
-spontaneous abortion may have been due to
deliberate interference earlier

7. Spontaneous or induced
First trimester or second trimester
Induced abortion can be legal or
criminal.
Most criminal abortions are unsafe.

8. Could be classified into fetal and maternal
factors
A) Fetal anomaly
Chromosomal
Structural
Genetic
B) Maternal disease
- pyrexia
- Diabetes mellitus
- Thyroid disease

9. C) Endocrine disorder
- early luteal phase defect
D) Uterine abnormalities
- fibroids, especially sub mucous
- congenital uterine anomalies
- intrauterine adhesions
- low implantation of the placenta

10. E) Infections
- malaria
- pyelonephritis
TORCHES
- toxoplasmosis
-rubella
- cytomegalovirus infection
-Herpes viruses
-Ebsten Barr virus
-Syphylis

11. F) Autoimmune disease
- SLE
- Anticardiolipin antibodies
- Antiphospholipid antibodies

12. G) Immunological
- Rhesus iso immunization
H) Trauma
- Amniocentesis
-CVS
- Pelvic surgery

13.  Threatened
Inevitable
Incomplete
complete
Missed
Recurrent
*Septic

14. Threatened abortion
- Bleeding from uterus before age of viability
with cervix not dilated and fetus alive with or
without slight lower abdominal pain
- most common ( in 1/3 of pregnancies
- USS – normal GS
FH activity present
hcg normal
- prognosis good
- Bed rest
- Hospitalization may not be necessary

15. Inevitable abortion
- Vaginal bleeding with severe abdominal
pain and dilatation of the cervix
- Pregnancy cannot be redeemed and
must be terminated
- USS – GS irregular and may or may not
be smaller than the EGA
- GXM
- Oxytocics
- Evacuate
- AntiD

16. Incomplete abortion
- part of poc expelled but bleeding continues
due to retained tissues
- V/E
- USS*
- GXM
- Evacuate
- Tissue for histology

17. Missed abortion
- Fetal demise (12-28wks) before
expulsion
- May be preceded by decreased
pregnancy symptoms and signs
- Uterus not enlarging
- Blighted ovum* - absence of an embryo
in the GS within the first 12wks of
pregnancy as shown by an early USS
- Evacuate
- 25-30% develop DIC after 1mth if not
evacuated

18. Recurrent/ Habitual abortion
- Three or more abortions occurring
consecutively or interspersed between term
pregnancies
- Clinical not pathological diagnosis
- prognosis good when diagnosed ( >60%
salvage rate)
- Management aimed at conditions amenable
to treatment

19. Cervical incompetence
- Typical history
- Serial V/E
- USS/HSG
- Cerclage
Myomas – especially submucous
- USS
- Myomectomy
Hormonal – mid follicular LH/FSH
- TFT, FBS

20. Autoimmune – SLE (lupus anticoagulant
- Anticardiolipin antibodies
- Blood group
Karyotyping of parents
Infections – Infection screen/VDRL

21. Complications of abortion
Early
- Haemorrhage
- Sepsis
- Failure to recognise ectopic
Long term
- chronic PID
- chronic pelvic pain
-pelvic abcess
- Ashermans syndrome
- Ectopic pregnancy
-Infertility

22. The World Health Organization has defined
unsafe abortion as “the termination of an
unintended pregnancy either by persons lacking
the necessary skills or in an environment lacking
the minimal medical standards or both”
-WHO Report of a Technical Working Group, 1992
Unsafe abortion is a major cause of maternal
mortality in developing countries
Factors associated with high rates of abortion
mortality in these countries include inadequate
access to contraception, restrictive abortion
laws, pervading negative attitudes to abortion
and poor health infrastructures

23. 3 3 0
6 8 0
2 8 3
1 1 9
0 . 7
0
1 0 0
2 0 0
3 0 0
4 0 0
5 0 0
6 0 0
7 0 0
8 0 0
A l l
D e v e l o p i n g
A f r i c a S o u t h &
S o u t h E a s t
A s i a
L a t i n
A m e r i c a
D e v e l o p e d

24. - Empathetic and compassionate pre-procedure
counseling of women experiencing complications
of abortion
- Quality management with MVA
-use of antibiotics
- Post procedure counseling to encourage the use
of contraceptives to prevent repeat abortion.
-effective link up to FP and other RH services
Expanded concept:
- Training of service providers, especially
doctors, to handle both complicated as well as
uncomplicated abortions.
-Provision of MVA Kits.

25. Primary
- provision of RH information and services
needed for women and (men) to make informed
choices and prevent unwanted pregnancies
- provision of quality sexuality education to all
age groups
- promotion of all form of FP methods (including
abstinence)
- Establishment of sustainable contraceptive
delivery services that would ensure that sexually
active people have access to effective methods
of contraception

26. Secondary
- programs and activities aimed at
providing information and counseling to
women experiencing an unwanted
pregnancy. Restrictive abortion laws
hinder this aspect.
Tertiary
- Provision of services for the treatment
of women suffering complication of
unsafe abortion.

27. Tertiary contd
- Pre-service training of health providers
as well as in-service training of staff on
all aspects of abortion and post abortion
care, contraceptive delivery and quality
of care frameworks
- inclusion of all components of sexual
and reproductive health and rights in the
training curricula of all health care
workers in Africa

28. -Abortion is an important public health problem in sub-
Saharan Africa.
A public health approach based on primary, secondary and
tertiary prevention can reduce the rate of mortality
associated with induced abortion in developing countries.
Efforts to address abortion and abortion mortality can
contribute to the attainment of the Millennium
Development Goals in these countries.
-Obstetricians and Gynecologists in Africa have a
leadership role to play in this direction- draw attention
and mobilize policy makers and community leaders to find
relevant and locally appropriate solutions.