Abortion and Post-abortion care

Abortion

• Introduction• Definition:• Classification - clinical, onset, legal• Magnitude - global, Africa, Ethiopia

- spontaneous, induced• Outcome and complications• Cost to the health system

Spontaneous abortion

• Mechanism and pathology• Risk factors– Age– Multiple pregnancy– Pregnancy interval– Gravidity– Previous abortion– Early menarche

Etiology

• Early Vs Late

• Fetal – Ovofetal – Aneuploidy, – Euploidy

Maternal

• Infections• Endocrine• Social drugs• IUCD• Radiation• Laparotomy• Aging gamets

• Chronic diseases• Immunological• Toxins• Malnutrition• Uterine defects• Trauma – iatrogenic• Paternal

Clinical features, Diagnosis

• Hx• P/E: general, abdomen, pelvic• Lab: depends on clinical state• Clinical types– Threatened - Inevitable– Incomplete - Complete– Missed - Recurrent, Habitual– Septic

Differential diagnosis

• Ectopic pregnancy• Molar pregnancy• AUB/HMB• Local causes• Urinary tract, GI tract bleeding

Induced abortion

• Therapeutic – medical reasons• Elective (voluntary) – on demand– Prochoice Vs Antichoice– Counseling– Worldwide, Africa– Ethiopia

Ethiopia

• Termination of pregnancy by a recognized medical institution within the period permitted by the profession is not punishable where:– The pregnancy is a result of rape or incest; or – The continuation of the pregnancy endangers the life of the mother or

the child or the health of the mother or where the birth of the child is a risk to the life or health of the mother; or

– The fetus has an incurable and serious deformity; or– The pregnant woman, owing to a physical or mental deficiency she

suffers from or her minority, is physically as well as mentally unfit to bring up the child.

Post abortion care

• Definition: – Comprehensive, based on individual needs

• Justification/rationale• Unsafe abortion, consequences

PAC: five elements

• Community-service provider partnership• Counseling• Emergency treatment of incomplete abortion

and its complications• FP services• Linkage with other RH services

Consequences of unsafe abortion

Unsafe abortionUnsafe abortionUnsafe abortionUnsafe abortion

Social Economic

Maternal deathMedical,

psychological

• Unsafe abortion is a leading cause of maternal mortality:– 13% - worldwide– 17% - east Africa

Causes of Maternal Death, Ethiopia*

*Facility based, Ethiopia

Risk factors related to abortion mortality

• Age• General state of health• Gestational age• Method of termination• Technical competence• Availability and accessibility of facilities

The right to life: No woman should die from pregnancy and childbirth.