Surveillance of
                  Abortion
Under supervision:
Dr. Farah Asad Mansuri
Associate Professor & Head, Departmen...
RESEARCHERS:

 FAUZAN ALAM HASHMI
 ZOHAIB AHMED
 M. SALMAN GHAZNI
 HAJI ISMAIL SIDDIQ
 M. TAHA
CONTENTS:

   INTRODUCTION
    OBJECTIVES
    MATERIAL & METHODS
    RESULTS
    CONCLUSION
    ACKNOWLEDGEMENT
    REFER...
INTRODUCTION:
• Induced abortion is one of the greatest human
  rights dilemmas of our time.
• The need for scientific and...
• Every year, approximately more than 210
  million women throughout the world discover
  that they are pregnant.
According to a report published on 11th October 2007 by
Guttmacher Institute Newyork, USA and World Health
Organisation, G...
• Nearly 44% of these abortions were
  performed under illegal conditions.

  ▫ share of illegal abortions was higher in t...
• It is observed that in Pakistan an estimated
  890,000 induced abortion are annually

• These may often be in unsaved co...
Objectives:

                                Objectives



                                                       Specific...
Materials & Methods:
 STUDY DESIGN:

 • Descriptive study
 • 6 months Sentinel Surveillance.

 Study was carried out in ...
Data was collected from 1st January 2008 till 30th June
 2008.

Structured questionnaire was filled from the records of
...
Results
1. Frequency of abortion in different
hospitals
                     ASH17%
          Civil
        HOSPITAL
          37%...
2. Category of abortion
         70.00%
         60.00%
         50.00%
         40.00%
         30.00%
         20.00%
  ...
• In 6 months of study in the 4 major teaching
  hospitals of Karachi, there were only 22 cases
  (3.4%) of induced termin...
3. Frequency of abortion related to
age
                 64.80
                   %
   13.40                     21.40
   ...
since most of the cases we recorded were
spontaneous abortions. The results were
remarkable:
 • According to our study, mo...
4. Frequency of abortion according to
parity:
                primi , 0
               parous
               15.80%
 grand...
• 11.1 % of the subjects had one child while 9.1%) 2
  & 5.7% more than

• 47.6% of the women who had the abortions
  prev...
MULTIPAROUS women were greatest in
number (66.1%) in our study.
• This is not in accordance with a study at
  Hyderabad, P...
5. Number of previous abortion
    0.2%
7

    0.4%
6

    0.4%
5

    0.8%
4

     2.2%
3

       6.1%
2

               ...
6.Abortions related to age [p=0.012]
        200
        180
        160
        140
                      no previous
   ...
7. Abortion related to period of gestation

                        14% at
                   0
                       8 w...
8. Conduction of abortion
    90%
    80%
    70%
    60%
    50%
    40%
                           82%
    30%
    20%
 ...
9. Most common method of
management of abortion found:
    Dialate , curette
                         Evacuation
     & ev...
• On analysis on category of abortion against
  method of abortion, (P< 0.03), majority of the
  cases were spontaneous in...
Reasons of abortion



  In 99.4% of cases we could not
  detect any reason of abortion.
• The largest number of women was those, having
  fetal loss for the first time (67.8%), followed by
  women who previousl...
Recommendations :
• Induced Abortions should be legalized in
  Pakistan, to prevent backstreet abortions and
  threatening...
Acknowledgements:
We are intensely indebted to the contributions of:

Professor Shershah Syed- Head Department of
 Obstetr...
• Professor Ghufrana Memon- Head Department
  of Obstetrics and Gynecology, Civil Hospital
  Karachi.
• Dr. Rubina Izhar- ...
Thank you
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Surveillance Of Abortion Symposium E97

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Surveillance Of Abortion Symposium E97

  1. 1. Surveillance of Abortion Under supervision: Dr. Farah Asad Mansuri Associate Professor & Head, Department of Community Medicine , KM&DC
  2. 2. RESEARCHERS: FAUZAN ALAM HASHMI ZOHAIB AHMED M. SALMAN GHAZNI HAJI ISMAIL SIDDIQ M. TAHA
  3. 3. CONTENTS: INTRODUCTION OBJECTIVES MATERIAL & METHODS RESULTS CONCLUSION ACKNOWLEDGEMENT REFERENCES
  4. 4. INTRODUCTION: • Induced abortion is one of the greatest human rights dilemmas of our time. • The need for scientific and objective information on the matter is therefore imperative. • Because unsafe abortion is a cause of maternal mortality & morbidity , measures of its incidence are also important for monitoring progress towards MILLENIUM DEVELOPMENT GOAL 5.
  5. 5. • Every year, approximately more than 210 million women throughout the world discover that they are pregnant.
  6. 6. According to a report published on 11th October 2007 by Guttmacher Institute Newyork, USA and World Health Organisation, Geneva, Switzerland: • an estimated 42 million abortions were induced in 2003, compared with 46 million in 1995. • The induced abortion rate in 2003 was 29 per 1000 women aged 15–44 years • 48% of all abortions worldwide were unsafe, and more than 97% of all unsafe abortions were in developing countries.
  7. 7. • Nearly 44% of these abortions were performed under illegal conditions. ▫ share of illegal abortions was higher in the developing countries (54%) • compared to the developed countries (9 % only). • The corresponding share was even higher in the countries in the Southeast Asian region (60 %).
  8. 8. • It is observed that in Pakistan an estimated 890,000 induced abortion are annually • These may often be in unsaved condition and at the hands of unskilled providers. • In Pakistan, although the contraceptive prevalence rate has increased from 9% to 24%, yet majority of women is unaware of different contraceptive methods available
  9. 9. Objectives: Objectives Specific General the age, parity category of the frequency of INDUCED and period of abortion & method AND SPONTANEOUS gestation at which of management ABORTIONS REPORTED in most abortions the tertiary care teaching most prevalent. are taking place hospitals of Karachi
  10. 10. Materials & Methods: STUDY DESIGN: • Descriptive study • 6 months Sentinel Surveillance. Study was carried out in Obstetrics and Gynaecology Departments of four major tertiary care teaching hospitals of Karachi: 1. Abbasi Shaheed Hospital, 2. Civil Hospital Karachi units I II III, 3. Sind Government Qatar Hospital, from the public sector 4. Liaquat National Hospital, from the private sector,
  11. 11. Data was collected from 1st January 2008 till 30th June 2008. Structured questionnaire was filled from the records of above mentioned hospitals. The sample came out to be a total of 650.
  12. 12. Results
  13. 13. 1. Frequency of abortion in different hospitals ASH17% Civil HOSPITAL 37% LNH 14% SGQH 32%
  14. 14. 2. Category of abortion 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% induc sp sp threat inevit misse ed septic compl incom termi ened able d ete plete nation categoryof abortion 2.90% 61.50% 3.40% 2.80% 3.10% 25.20% 0.60%
  15. 15. • In 6 months of study in the 4 major teaching hospitals of Karachi, there were only 22 cases (3.4%) of induced termination of pregnancy. • This is not linked harmonically to facts and figures which state that 890,000 induced abortions take place annually in Pakistan.
  16. 16. 3. Frequency of abortion related to age 64.80 % 13.40 21.40 % % 0.4% 16-20 years 21-30years 31-40years 41-60years
  17. 17. since most of the cases we recorded were spontaneous abortions. The results were remarkable: • According to our study, most of the spontaneous abortions (64.8%) have arisen from the age range 21-30 years followed by age range 31 – 40 years. • More than 40 years of age and less than 20 years of cases were less. • There was also a case found of age more than 50 years.
  18. 18. 4. Frequency of abortion according to parity: primi , 0 parous 15.80% grand multi parous 18.20% Multi parous 66.10%
  19. 19. • 11.1 % of the subjects had one child while 9.1%) 2 & 5.7% more than • 47.6% of the women who had the abortions previously have had a live birth and did not have a previous abortion.
  20. 20. MULTIPAROUS women were greatest in number (66.1%) in our study. • This is not in accordance with a study at Hyderabad, Pakistan where 28.12% women were primigravidae and 59.37% were grand multigravidae • while Saeed AG from Islamabad, Pakistan has reported 11.55% patients as primigravidae and 57.8% multigravidae.
  21. 21. 5. Number of previous abortion 0.2% 7 0.4% 6 0.4% 5 0.8% 4 2.2% 3 6.1% 2 21.9% 1 67.8% 0 0 10 20 30 40 50 60 70 80 PERCENTAGE
  22. 22. 6.Abortions related to age [p=0.012] 200 180 160 140 no previous 120 abortion 100 80 one previous 60 abortion 40 20 2 or more than 0 2 previous abortions
  23. 23. 7. Abortion related to period of gestation 14% at 0 8 weeks 11.8% 8 weeks at 51% at 12 weeks 12week 10 10 weeks s weeks
  24. 24. 8. Conduction of abortion 90% 80% 70% 60% 50% 40% 82% 30% 20% 3% 10% 15% 0% DAI DOCTOR NONE
  25. 25. 9. Most common method of management of abortion found: Dialate , curette Evacuation & evacuation 14.8% 64.5% Method Vacuum Prostaglandins aspiration induced 7.8% 1.1%
  26. 26. • On analysis on category of abortion against method of abortion, (P< 0.03), majority of the cases were spontaneous incomplete abortion of whom D&E had been performed (271 cases) • followed by missed abortion cases on which D&E had been performed (106 cases) • Vacuum aspiration was also a frequent method of abortion in Spontaneous incomplete and Missed abortions. • Hysterectomy and use of prostaglandins were used only in complicated cases. • Complicated D&Es were also done under General anesthesia in operation theatre.
  27. 27. Reasons of abortion  In 99.4% of cases we could not detect any reason of abortion.
  28. 28. • The largest number of women was those, having fetal loss for the first time (67.8%), followed by women who previously had only 1 abortion (21.9%). • The greatest number of women being those who were multiparous and had no previous abortion before (P< 0.0001)
  29. 29. Recommendations : • Induced Abortions should be legalized in Pakistan, to prevent backstreet abortions and threatening the lives of women under the hands of unskilled personnel. • Gynecologist must seriously take some measures to educate & guide women of child bearing age in our society by launching campaigns to plan & safely execute a pregnancy, to avoid spontaneous abortions.
  30. 30. Acknowledgements: We are intensely indebted to the contributions of: Professor Shershah Syed- Head Department of Obstetrics and Gynecology, Sindh Govt. Qatar Hospital. Professor Azra Sultana- Head Gynecology Unit- 2, Abbasi Shaheed Hospital. Professor Halima Hashmi- Head Department of Obstetrics and Gynecology, LNH
  31. 31. • Professor Ghufrana Memon- Head Department of Obstetrics and Gynecology, Civil Hospital Karachi. • Dr. Rubina Izhar- Head Gynae Unit- 3, Abbasi Shaheed Hospital. • All the Post Graduate trainees of Sindh Govt. Qatar Hospital, Abbasi Shaheed Hospital, Liaquat National Hospital& Civil hospital Karachi, who helped us a lot during the research.
  32. 32. Thank you
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