PMAC

• One of the element of Reproductive

Health
• Created through Adm Order I-AS, 1998

• Aims to address the Health and Medical

care needs of many Filipino women who
have had abortion, regardless of cause.
Theme:

• To give QUALITY and HUMANE Post-

abortion care services by COMPETENT,
COMPASSIONATE, OBJECTIVE and NON
JUDGEMENTAL SERVICE PROVIDER IN A
WELL EQUIPPED INSTITUTION
Complimented by SUPPORTIVE
ENVIRONMENT.
• In addition women with THREATENED
Abortion are also given care to prevent
them from progressing into complete
abortion.
• Likewise, preventive measures that
established will ensure future pregnancies
are properly timed,thereby excluding
abortion.
GOAL

• To improve the quality of Health Care

Services for the Prevention and
Management of Abortion and its
complication in the Philippines
ABORTION

• Is a well known problem, although most

abortions are done secretely, its often only
when someone dies or get sick or having
complication that the problem becomes
known.
• Accurate data on abortion is Hard to
obtain.
• Young girls are at highest risk of
unwanted pregnancy and unsafe abortion.
• because when they fall pregnant, they
don’t know what to do. They choose to
abort because at home parents won’t
tolerate it. She knows she will be of great
dissapoinment and bring shame to the
family.
• when they find they can no longer hide
the pregnancy, they often decide to abort
and still keep on hiding and hope that
things will be alright. As a result they
come late for help, when they can no
longer cope
Causes of UNWANTED pregnancy:
• - economic
• - poor parenting
• - ignorance about sex and
reproductive health
• - early Physical maturity and
experimentation of sex,
promiscuity.
• - unprotected sex
• - peer pressure to have sex
• - change from traditional to
modern societal values
• - inacceptability of
contraceptives
• - women lack of control of their
sexuality
• - inadequate family
accomodation
• - boys and men cheating girls
into having sex by promising
marriage and lack of respect
between man and women.
• - men’s denial of responsibility for the
pregnancy and fear of family members
finding out about the pregnancy are major
causes of abortion.
Statistics:
• 2007 – 475,000 Abortion case
• - 1/3 of these are from ages 15-24
• Premarital Sex in the Philippines is
increasing and 20% of these occurs
among high school students.
Abortion are OBTAINED from
variety of Sources

• Including:
– Traditional healers
– Community members (often female elders)
– Health workers
– Self induced with assistance of friends and
other community members
• Most abortions are unskilled
• Methods used outside the formal
healthcare system include
– Oral administration of traditional medicine or
herb
– Overdosed of some malarial drugs
– Contraceptive pills
– Inserting catheter, stick or any hard objects
into the vagina.
• Girls and women who experience
complication of induced abortion often
delay or do not seek Medical treatment.
Primary reasons for Avoiding
Medical Attention

• FEAR
– Being reported to the police by clinic or
hospital Staff
– Harsh treatment and exposure by nurses
– Parents reaction
Generally,How can we Prevent
Unwanted & Unsafe Abortion:
• 1. COMMUNITY DIALOGUE AND
MOBILIZATION
• Recommended ACTION:
– Sensitize and educate on the dangers of
unsafe abortion and the need for prompt
Medical attention for complications and PAC.
– Encourage church attendance
– Establish and support programs for
youth
– Facilitate networking among community
organizations.
– Improve and expand PAL services.
– Involve elected officials and politicians
• 2. BETTER PARENTING
– Parents should provide more support to their
children
– Improve parent – child communication
– Teach their children about sex
– Exercise more discipline over their children
– Better role model which focuses on abstinence
that should be taught in school.
• 3. seek prompt medical treatment
• 4. expand and improve PAL Services,
confidentiality counselling, support.
• 5. sensitize traditional HEALERS to the danger
of abortion (sentil induces)
• 6. continue dialogue on policy issues
• 7. teach sex education in school
• 8. to prevent unwanted pregnancy and
abortion complication
Post Abortion care to prevent
further COMPLICATION:
• Practice the following;
– Privacy
– Confidentiality
– Dignity (Self worth)
– Compassion
– Being non judgemental
Steps in the Management:

• 1. gather data accurately

• 2. establish diagnosis
• 3. counseling:
– On the patients condition
– Neccessary procedures (Laboratory &
Diagnostic Management)
– Possible outcome
EMERGENCY CAUSES:
– Profuse bleeding
– Hypotention
– Fever and chills
– Severe pain
• If you have the following then focus first on
the Medical problem- administering
neccessary EMERGENCY MEASURES.
• If your facility is not capable of definitive
management
- refer to nearest hospital
* If capable of treating the
complication,
* get consent (from nearest relative)
* proceed
Management of the different types
of abortion:
• I. THREATENED
– Bed rest
– Progesterone (Didrogesterone)
– Treat infection (if present)
– Recurrent – chromosomal- none Habitual
II. 2nd Trimester:

– Bed rest
– Tocolytil
– Treat infection (if present)
HABITUAL ABORTION:
a) Incompetent cervix: cervical cerlage
b) APAS (Antiphospholipis antibody syndrome)
- ASA (aspillet) 80 mg/day
- Heparin
III. 3rd trimester:

– Bedrest
– Tocolytic
– Treat infection
II. ABORTION INCOMPLETE
– Completion curettage
– MVA (manual Vacuum Aspiration)

Intrauterine Embryonic Demise:

- evacuation and Curettage
III. INEVITABLE ABORTION:

• If no further gush of fluid within 48 hrs.,

patient can get up and do usual activity.
• If futher gush of fluid is noted and fever
ensure, then consider of inevitable and
uterus has to be emptied.
• NB: if ultrasound is available request for
TV or POS to determine status of fetus
and amout of amiotic fluid.
IV. MISSED ABORTION

• If detected and cervix is close, prine the

cervix/ induce to evacuate product of
conception
• Then do completion curettage or MVA to
completely evacute the uterus.
• NB: if retainned for several weeks it may
cause serious coagulation problem.
INDUCED ABORTION

• 1. NON SEPTIC (no sign of infection)

– Evacute
Threatened abortion:
- Tocolytic

SEPTIC ABORTION
- Treat infection
- Give ATS
- evacuate
Prior to Discharge:
– Counsel patient on different family planning
method and let the patient decide on what
she prefer to use.
– Refer to infections unit if present in your
institution, nut if not do counsel patients on
the infections diseases – sexually transmitted
that patient can acquire from sexual
intercourse
• 1. combine oral contraceptive
• 2. Nonplant
• 3. DMPA