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
Spontaneous Abortion

Threatened Abortion

Inevitable Abortion
(including belighted ovum and missed abortion)

Incomplete Abortion

Complete Abortion

Threatened Abortion
    

Mild to moderate vaginal bleeding Uneffaced and undilated cervix No abdominal pain Fetus often viable Conservative management

Inevitable Abortion
1. 2.


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

1. 2.


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

 

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


Abortion issue

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

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