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Unsafe Abortion: An Experience In A Private Setting Objectives: To determine the frequency, risk factors and complications of unsafe abortion. Study Design: Descriptive case series.Settings: The study was carried out at a private Hospital (Begum Jan Hospital Lehtrar Road Islamabad) from 1st July 2007 to 31st Dec 2008. Patients and Methods: During the study period 35 patients came with complications after induced abortion. Sampling technique was convenient sampling. Questionnaire was designed including mixed type of questions about variables like age, parity, marital and educational status, indication and method used for abortion, qualification of abortion provider, contraceptive usage and complications in abortion seeker. Descriptive statistics were analyzed in the form of percentages by using SPSS version 10. Results: Thirty five patients were admitted with complicated unsafe abortion. The mean ± SD (29.14 ± 5.36 years) age was 30 years, 95% were married and multiparous, 80% were not educated and 15% had primary education, 90% approached unqualified paramedics who did instrumentation resulting in complications. Thirty percent were contraceptive users. Conslusion: Unsafe abortion is an important public health problem and frequency is high in rural areas. Uneducated women indulge in unsafe abortion without utilizing the services of contraceptive measures. It is observed that our rural population do not have clear and complete information of contraceptives and unaware of the sequelae of unsafe abortions. Key Words: Unsafe abortion, Induced septic abortion, Methods of termination of pregnancy, Complications of abortion. Introduction Unsafe abortion is a procedure to terminate an unintended pregnancy undertaken either by individual lacking the necessary skills or in an environment that does not meet basic medical standards1, 2.WHO estimates that on an average 10–20 million women risk their lives annually by subjecting themselves to termination of pregnancies resulting in a death of 68000 – 70000 and many other suffer acute and chronic morbidities which are even difficult to estimate and quantify3, 4, 5. Different hospital based studies showed that maternal mortality due to induced abortion in Pakistan ranges between 10-11% of all maternal deaths 6. Although in Pakistan the contraceptive rate has increased from 9% to 24%, yet majority of the women have unintended pregnancies7. This is especially common in rural areas either due to non availability of contraceptives or due to unclear and incomplete information about methods of family planning. Unwanted pregnancies, poverty, lack of availability and accessibility to contraception and contraceptive failure are some of the factors that account for the rise in the number of women seeking termination of pregnancies in unsafe conditions 8, 9, 10Majority of them are married, pregnancy outside of marriage constitutes very small component of total number of patients seeking termination of pregnancy 9. Termination of pregnancy is done by traditional birth attendants who are available in the vicinity. Once complicated, they refer the cases to the nearest hospital. Most important complication is incomplete abortion leading to hemorrhage and later on infection. Other most serious complications are uterine trauma, abdominal visceral injuries, shock, anaemia, disseminated intravascular coagulation, and thromboembolism. These complicated unsafe abortions increase the burden on families, health professionals, health facilities and ultimately on national economy¹¹. In developing countries sepsis is an important contributor to maternal mortality and morbidity. Both medical and surgical methods are used for termination of pregnancies but surgical interference like evacuation and curettage is the commonest method 9 12. This surgical interference can be a source of increased risk of infections like HIV (AIDS), Hepatitis B and C viruses along with other bacterial infections ¹³.Aim of this study was to find frequency, risk factors and complications of unsafe abortion. Patients and Methods This descriptive study was carried out on patients who came with history of induced abortion during one and a half year time period form 1st July, 2007 to 31st Dec, 2008 at a private Hospital (Begum Jan Hospital Lehtrar Road in Islamabad) situated in the suburb of Islamabad receiving patients fro rural areas of Rawalpindi. Thirty five patients who presented with complicated unsafe abortion were included in the study. Sampling technique was convenient sampling. Other patients with incomplete, inevitable and missed abortions were not included in the study. |
Qaisar Jahan* Mahreen Mahmood** Khalida Waheed***
*Consultant Gynaecologist ** Associate Professor Gynaecology & Obstetrics , Islamabad Medical & Dental College, (IMDC) Bhara Kahu* ***Chairperson Representative Committee RCOG. Head Of Gynaecology & Obstetrics Department, Islamabad Medical & Dental College, Bhara Kahu** For data collection a questionnaire containing open and closed ended questions was developed. Information about age, marital and educational status, parity, reason for abortion and qualification of abortion provider, method used for termination of pregnancies, awareness, attitude and use of contraceptives and its failure were recorded. Special inquiry was made whether they were aware of the extent of the life threatening damage and complications that can occur with unsafe procedure used for the termination. Questionnaire was filled after taking informed verbal consent in an interview. For assessment of complications history was takenregarding vaginal bleeding, abdominal / pelvic pain, fever, abdominal distention and other symptoms. Detailed systemic examination was performed with special evaluation of the pelvis. Relevant investigations available in the setup were complete blood picture, blood group and Rh factor, mid stream specimen of urine for microscopy, coagulation profile, renal function tests and viral screening for hepatitis B & C and high vaginal swab for culture and sensitivity. Pelvic ultrasound was performed. After primary resuscitation the patients were managed according to the complications. Those with retained products of conception and requiring only evacuation were managed in the same setting after hemodynamic stability, correction of anemia and antibiotic cover. Those with signs of septicemia and other serious complications like visceral injuries to the uterus, intestines were referred to the tertiary care hospitals within eight hours. Postoperative care was given for 24 hours and patients followed up for one month.. Data was analyzed by using S.P.S.S version 10. Descriptive statistics in terms of percentages were determined. Results During the study period 2010 patients were examined in the Gynae department for obstetrics and gynaecological indications. Out of these , 290 were admitted with abortion related complaints. Thirty five women out of 290 gave history of unsafe abortion showing 12.06% of total abortions and annual hospitalization rate of 17/1000. There was no maternal death in these 35 patients.The age of the patient ranged between 15-45 years with the mean + SD (29.14 + 5.36) years. The median age was 30 years. Sixty five percent patients were in the range of 26-35 years. (Table I)Table I Age group related to induced septic abortion. (n=35)
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