Surveillance Of Abortion  Symposium E97
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  • 1. Surveillance of Abortion Under supervision: Dr. Farah Asad Mansuri Associate Professor & Head, Department of Community Medicine , KM&DC
  • 2. RESEARCHERS: FAUZAN ALAM HASHMI ZOHAIB AHMED M. SALMAN GHAZNI HAJI ISMAIL SIDDIQ M. TAHA
  • 3. CONTENTS: INTRODUCTION OBJECTIVES MATERIAL & METHODS RESULTS CONCLUSION ACKNOWLEDGEMENT REFERENCES
  • 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. • Every year, approximately more than 210 million women throughout the world discover that they are pregnant.
  • 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. • 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. • 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. 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. 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. 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. Results
  • 13. 1. Frequency of abortion in different hospitals ASH17% Civil HOSPITAL 37% LNH 14% SGQH 32%
  • 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. • 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. 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. 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. 4. Frequency of abortion according to parity: primi , 0 parous 15.80% grand multi parous 18.20% Multi parous 66.10%
  • 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. 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. 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. 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. 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. 8. Conduction of abortion 90% 80% 70% 60% 50% 40% 82% 30% 20% 3% 10% 15% 0% DAI DOCTOR NONE
  • 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. • 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. Reasons of abortion  In 99.4% of cases we could not detect any reason of abortion.
  • 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. 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. 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. • 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. Thank you