2. INTRODUCTION
Abortion is the expulsion or extraction of an embryo or fetus weighing 500 g or less from
its mother when it is not capable of independent survival (i.e. before the period of
viability)
Incidence 10–20% of all clinical pregnancies
75% abortions occur before the 16th week
Rates vary with maternal age; also high in women with past miscarriages
3.
4. SPONTANEOUS
DEFINTION: It refers to the premature expulsion of the products of conceptions (embryo or
foetus) from the uterus, usually before the 20th week of pregnancy. An abortion may be
spontaneous (naturally occurring also called miscarriage) or induced (intentionally
performed). The expelled embryo or foetus is called abortus.
5. Isolated spontaneous abortions may result from certain viruses
—most notably cytomegalovirus, herpesvirus, parvovirus, and rubella virus
—or from disorders that can cause sporadic abortions or recurrent pregnancy loss (eg,
chromosomal or mendelian abnormalities, luteal phase defects).
SPONTANEOUS
6. A threatened abortion is vaginal bleeding that occurs in the first 20 weeks of pregnancy.
The bleeding is sometimes accompanied by abdominal cramps.
Inevitable abortion can come after a threatened miscarriage or without warning. There is
usually a lot more vaginal bleeding and strong lower stomach cramps
Complete abortion is a completed miscarriage. Typically, a history of vaginal bleeding,
abdominal pain, and passage of tissue exists. After the tissue passes, the patient notes that
the pain subsides and the vaginal bleeding significantly diminishes
SPONTANEOUS
7. An incomplete abortion is the partial loss of the products of conception within the first 20
weeks. Incomplete abortion usually presents with moderate to severe vaginal bleeding,
which may be associated with lower abdominal and/or pelvic pain
A missed abortion is a miscarriage in which the fetus doesn’t form or has died, but the
placenta and embryonic tissues are still in the uterus
SPONTANEOUS
8. Septic abortion is serious uterine infection during or shortly before or after
an abortion. Septic abortions usually result from induced abortions done by untrained
practitioners using nonsterile techniques; they are much more common when
induced abortion is illegal. Infection is less common after spontaneous abortion.
SPONTANEOUS
9. SPONTANEOUS
Habitual (or recurrent) abortion refers to a history of repeated miscarriage, defined as
three or more successive pregnancy losses
10. INDUCED ABORTION
Nearly 40% of the nearly 182 million pregnancies each year in the developing world are
unwanted or ill-timed.
46 million unwanted pregnancies end in abortion each year, 20 million of which are
unsafe or illegal.
An unwanted pregnancy is a pregnancy that a woman or girl decides, of her own free will,
is undesired or un planned for.
11. INDUCED ABORTION
Illegal/ Unsafe abortion – defined as a procedure for terminating an unwanted pregnancy
either by persons lacking the necessary skills or in an environment lacking minimal medical
standards or both
Medical Termination of pregnancy-A medical abortion, also known as medication abortion,
occurs when medically-prescribed drugs are used to bring about an abortion or surgical
means .
13. A. Fetal Factors
1. Genetic
– 50% of early miscarriage is due to chromosomal abnormalities
– Numerical defects like Trisomy, Polyploidy, Monosomy
– Structural defects like translocation, deletion, inversion
2. Multiple Pregnancies
3. Degeneration of villi
BIOLOGICAL CAUSES
19. LEGAL ISSUES WITH ABORTION
Approximately 20 million unsafe abortions take place each year. More than 200 women die
every day from complications of unsafe abortion % of abortion-related deaths and
complications occur in the developing world. unwanted pregnancy and unsafe abortion
20. WORLD’S ABORTION LAWS
Percentage of world’s women living in countries where abortion is permitted, various conditions.
Prohibited entirely- 4%
To save a woman's life- 25%
Physical health- 42%
Mental health-10%
Socioeconomic grounds-3%
Without restrictions- 20%
21. CHALLENGES WITH ACCESS TO ABORTION SERVICES
It should be noted that even where abortion is permitted by law, women often encounter obstacles when
seeking to end a pregnancy, including:
High cost
Difficult access
Inadequate facilities
Social stigma
Poorly trained and unsympathetic medical personnel.
Lack of knowledge about abortion services
22. CONSEQUENCES OF UNSAFE ABORTION
Some hospitals in developing countries
spend as much as 50% of their obstetric
and gynecological budgets treating
complications of unsafe abortion.
Disability and its effects
Economical lose
Mortality and its consequences
Social discrimination
Social lose
Adversely affects sexual relationships
23. ADDRESSING UNSAFE ABORTION
Unsafe abortion is a public health concern that affects the lives of tens of thousands of women, children, and
families each year.
1. Ensuring that changes in abortion laws are accompanied by supportive policies and service delivery
guidelines that promote safe
2. Availability of services in health centers
3. high quality services
4. Ensuring greater access to comprehensive sexual and reproductive health services including high quality
care for abortion complications and safe services for legal termination of pregnancy
5. Refraining from prosecuting women who have had abortions
24. ADDRESSING UNSAFE ABORTION
6. Advocacy for safe abortion services.
7. Educating the girl child.
8. Provision of youth and adolescent friendly services
9. Training of the health workers
10. Advocacy for Sexuality education for the youth
11. And many more
25. Service providers Must:
Be well-informed about the status of the law
Offer women high quality services and a choice of appropriate technologies
Provide confidential, compassionate counseling
ADDRESSING UNSAFE ABORTION
26. As already noted before, Most of the induced abortions are induced. There fore, to reduce
the prevalence of un safe abortions un wanted/ unintended pregnancies must be addressed
SO…………..
What are the causes of unintended pregnancies?…….and
How can they be addressed?
27. CAUSES OF UNINTENDED PREGNANCIES
Lack of information about sexuality
Culture and social beliefs (early
marriage)
Religion (contraceptive use)
Poor parenting/ lack of family support
Failure to access to contraceptives
(availability)
Policies
Sexual harassment and abuse
Poverty
Failure to educate the girl child
Health concerns
Personal beliefs attitudes and
perceptions
Un friendly family planning services
Etc
28. SO WHAT CAN BE DONE TO REDUCE THE PREVALENCE
OF UNINTENDED PREGNANCIES
Discuss this in groups of 3 in
……………………5 minutes………………………
30. OBJECTIVE
To equip learners with knowledge and good attitude in the management of women with
abortion.
31. COMPLICATIONS OF ABPORTION
Haemorrhage
Septicaemia
Bacteraemia shock with rigors, nausea, vomiting, diarrhoea, hypotension, confusion,
delirium and coma
Renal failure
Secondary
infertility
32. MANAGEMENT OF A WOMAN WITH ABORTION
General management of abortion
The woman with abortion must be admitted to gynaecological ward for close observation
and treatment
History taking to obtain possible aetiological factors together with details of bleeding,
pain and products of conception expelled
Perform a full physical examination
33. Check and record vital signs i.e. temperature, pulse, respiration and blood pressure
Observe aseptic technique when performing vaginal examinations
Provide pads to observe severity of blood loss
Put up intravenous fluids if the woman is bleeding severely i.e. normal saline, ringers
lactate
MANAGEMENT OF A WOMAN WITH ABORTION
34. If necessary Check Hb, grouping and cross matching and arrange for blood donor
Give antibiotics to treat infection in case of septic abortion
MVA is the method of choice for the management of incomplete or inevitable abortion
for gestation of 14 weeks or less, because it has fewer complications compared to
curettage.
MANAGEMENT OF A WOMAN WITH ABORTION
