2. Objectives.
• Define abortions.
• Name and discuss the different types of abortions.
• Name some maternal and foetal indications of
therapeutic abortion.
• Name some investigations required to confirm
diagnoses.
• Know the legal implications surrounding induced or
voluntary termination of pregnancy.
3. Plan.
• Definition.
• Classification of abortions.
Spontaneous
Induced /voluntary/ unsafe abortion.
Therapeutic abortion.
• Statistics on abortion.
• Diagnostic technique for foetal malformations.
• Indications for therapeutic abortions (foetal, maternal).
• Legal status of abortion in Cameroon.
• Perinatal medicine.
5. Statistics on abortion.
• 40-50 million abortions occur each year.
• About 20 million are unsafe abortions.
• 13 % of maternal deaths are due to abortion related
complications.
• At the Central Maternity Yaounde 30-40% maternal
deaths due to abortion complication.
• WHO estimates that 68000 women die each year while
hundreds of thousand others suffer morbidity from
abortion complications.
• Estimated that 1:150 abortions cause maternal death
and 99% of this occurring in the developing countries.
6. Statistics on abortion(1).
• 60-70% of first trimester abortions, chromosomal
abnormalities.
• 12-15% of all abortions are spontaneous.
• Spontaneous abortion, therefore a regulatory
mechanism to reduce the number of malformed foetuses
that get to term.
• True prevalence of induced abortion, difficult to estimate.
• Cervical incompetence commonest cause of second
trimester abortions.
Nana
7. Diagnostic techniques for foetal
malformations.
• Chorionic villi sampling, carried out after the 9 weeks of
pregnancy.- chromosome analysis. Risk: ? limb defects.
• Amniocentesis: carried out between 18-24 weeks of
pregnancy. –chromosome analysis, biochemistry,
hormone assay etc.
• HCG assay
• Ultrasonography, morphological studies, 20-24 weeks of
pregnancy.
• Maternal alpha foeto-proteins, very high in neural tube
defects.
• Maternal serology toxoplasmosis /rubella.
• Haemoglobin electrophoresis.
Nana
8. Indications for therapeutic abortions.
• Maternal causes:
Severe heart disease (New york class III/IV).
Malignancies (cervix, breast, etc).
Active rubella infection.
End stage diseases ? chances of having a pregnancy
rare.
• Foetal causes:
Foetal malformation incompatible with extra-uterine life
(anencephaly, severe neural tube defect, transposition of
great vessels, multi-organ malformation- kidney, GIT,
vertebral column).
Active rubella infection.
9. Legal status of abortion in Cameroon.
• Law on abortion is restrictive.
• Abortion legalised when the health of the mother is at
serious risk, foetal malformation incompatible with extra-
uterine life or when pregnancy resulted from rape or
incest.
• This is found in article 337-339 of the penal code.
• Demand to terminate pregnancy must be signed by
treating physician and counter signed by two other
colleagues.
• Demand is addressed to the minister of public heath,
through the head of the health faciity.
10. Perinatal medicine.
• New area of sub-specialisation in Obstetrics and
Gynaecology.
• Deals with prenatal diagnosis of some hereditary
diseases.
• Intra-uterine management, may include venopuncture,
intra-uterine transfusion and termination of pregnancy
where authorised by the law.
• Technology not available in our milieu today.
Nana
11. Conclusion.
• The law on abortion is restrictive.
• Abortion is punishable by law to the provider, the
aborted and sometimes the middle man.
• Unsafe abortion may lead to serious maternal morbidity
and mortality.
• However, the practice is still common in the developing
countries, for several reasons: law is restrictive, financial
constraint, fear of stigmatisation, protection of the
provider, lack of male support, fear of parents and then
desire to further education.
• It is worth emphasizing that abortion services be offered
women under the conditions authorised by the law.
