Concept of Abortion

1. By Rashmi Luintel
BN,BA,MPH
Lecturer
National Open College
Pokhara University

2. Abortion
• Abortion is the expulsion of the product of
conception before 20 weeks of gestation, or a fetus
weighing less than 500g( a/c to WHO).
• An abortion that occurs without intervention is
known as a miscarriage or spontaneous abortion.
• When deliberate steps are taken to end a pregnancy, it
is called an induced abortion.

3. Key facts of abortion
An estimated 1 in 4 pregnancies end in an abortion
every year.
• Each year between 4.7% – 13.2% of maternal deaths
can be attributed to unsafe abortion.

4. Key facts of abortion

5. Types of abortion
1. Spontaneous abortion
2. Induce abortion:
• Medical / safe abortion
• Unsafe abortion

6. Types of Spontaneous Abortion
• Complete abortion: All pregnancy tissues
have been expelled from your body.
• Incomplete abortion : You’ve passed
some tissue or placental material, but
some still remains in your body.
• Missed abortion : The embryo dies
without your knowledge, and you don’t
deliver it.

7. • Threatened abortion: Bleeding and
cramps accompanied possible upcoming
miscarriage.
• Inevitable abortion: The presence of
bleeding, cramping, and cervical dilation
indicates that a miscarriage is inevitable.
• Septic abortion: An infection has
occurred within your uterus

8. Causes of Abortion
• About 10% of all pregnancy ended in abortion.
• 75% of spontaneous abortions occur before the 16th
week of gestation and of these, 75% occur before 8
weeks of gestation.
• The causes of abortion are usually divided into:
 Fetal factor
 Maternal factor
 Paternal factor: genetic factor,
 Unknown

9. Causes of Abortion
Maternal factor
• Severe mental stress
• Infection.
• Exposure to high levels of radiation or toxic agents.
• Hormonal irregularities.
• Improper implantation of fertilized egg in the uterine lining.
• Maternal age.
• Uterine abnormalities.
• Incompetent cervix
• Lifestyle factors: smoking, drinking alcohol, drugs abuse.
• Autoimmune disease eg: lupus,
• Disease condition : Congenital heart disease, Uncontrolled
Diabetes, Thyroid disease, Severe kidney disease.
• Severe malnutrition.

10. Causes of Abortion
Fetal factor:
 Chromosomal anomalies accounts about 25% of early
abortion
 Multiple defects
 Multiple pregnancies
 Low lying placenta
Paternal Factor:
 Genetic
 Paternal age beyond 35 years
 lead exposure.
 Paternal BMI

11. Induce abortion
• Unsafe abortion
• Safe Abortion (Medical/ Surgical )
First trimester:
 Mifepristone orally, Misoprostole (orally/
vaginally), Methotrexate ( orally/ IM)
Manual Vacuum Aspiration( MVA)
Second trimester:
Dilation and Evacuation ( D&E)
Third trimester
Dilation and Extraction(D&X)

12. Unsafe Abortion
An abortion is unsafe when it is carried
out either by a person lacking the
necessary skills or in an environment that
does not conform to minimal medical
standards, or both.

13. Health effects of unsafe abortion
Immediate Complication
• incomplete abortion (failure to remove or expel all of
the pregnancy tissue from the uterus)
• haemorrhage (heavy bleeding)
• Infection/sepsis
• uterine perforation
• damage to the genital tract and internal organs by
inserting dangerous objects.
• Maternal death

14. Health effects of unsafe abortion
Long term complication
• Chronic pelvic pain
• Pelvic Inflammatory Disease (PID)
• Infertility
• Ectopic Pregnancy
• Premature Labour
• Abortion
• Psychological trauma

15. Health effects of unsafe abortion
Other problems
• Economic problems
• Legal problems
• Socio-cultural and religious problems
• Family relation problem etc.

16. Prevention and control
Unsafe abortion can be prevented through:
• Comprehensive reproductive health
education such as Preconception care,
Family planning method, knowledge
about safe abortion service.
• Prevention of unintended pregnancy
through use of effective contraception,
including emergency contraception.

17. • Availability and accessibility of family
planning services in the community.
• Scale up comprehensive abortion care to the
grassroots level.
• Coordinate with external development partners
( NGO/INGO) to introduce new technologies,
build the skills of staff including necessary
equipments and resources.
• Discourage sex selective abortion.

18. References
• D C Dutta’s textbook of Obstetrics, 7th edition.
• National Safe Abortion Policy, 2003 A D.
• Safe abortion service process 2060 B.S.
• https://www.who.int/news-room/fact-
sheets/detail/abortion.
• https://apps.who.int/iris/bitstream/handle/10
665/338768/factsheet-nepal-
eng.pdf?sequence=9&isAllowed=y