Surveillance Of Abortion Symposium E97Presentation Transcript
Dr. Farah Asad Mansuri
Associate Professor & Head, Department of
Community Medicine , KM&DC
FAUZAN ALAM HASHMI
M. SALMAN GHAZNI
HAJI ISMAIL SIDDIQ
MATERIAL & METHODS
• 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
• 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, 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
• 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 %
• The corresponding share was even higher
in the countries in the Southeast Asian
region (60 %).
• 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
the age, parity
the frequency of INDUCED
and period of
abortion & method
gestation at which
ABORTIONS REPORTED in
the tertiary care teaching most prevalent.
are taking place
hospitals of Karachi
Materials & Methods:
• 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
4. Liaquat National Hospital, from the private sector,
Data was collected from 1st January 2008 till 30th June
Structured questionnaire was filled from the records of
above mentioned hospitals.
The sample came out to be a total of 650.
1. Frequency of abortion in different
2. Category of abortion
threat inevit misse
termi ened able d
categoryof abortion 2.90% 61.50% 3.40% 2.80% 3.10% 25.20% 0.60%
• 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.
3. Frequency of abortion related to
since most of the cases we recorded were
spontaneous abortions. The results were
• 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
• 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
4. Frequency of abortion according to
primi , 0
• 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.
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
• while Saeed AG from Islamabad, Pakistan has
reported 11.55% patients as primigravidae and
6.Abortions related to age [p=0.012]
2 or more than
7. Abortion related to period of gestation
51% at 12 weeks
10 10 weeks
8. Conduction of abortion
9. Most common method of
management of abortion found:
Dialate , curette
• 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
• Hysterectomy and use of prostaglandins were
used only in complicated cases.
• Complicated D&Es were also done under
General anesthesia in operation theatre.
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 previously had only 1 abortion
• The greatest number of women being those who
were multiparous and had no previous abortion
before (P< 0.0001)
• 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.
We are intensely indebted to the contributions of:
Professor Shershah Syed- Head Department of
Obstetrics and Gynecology, Sindh Govt. Qatar
Professor Azra Sultana- Head Gynecology Unit- 2,
Abbasi Shaheed Hospital.
Professor Halima Hashmi- Head Department of
Obstetrics and Gynecology, LNH
• Professor Ghufrana Memon- Head Department
of Obstetrics and Gynecology, Civil Hospital
• Dr. Rubina Izhar- Head Gynae Unit- 3, Abbasi
• 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.