This document discusses abortion and bioethics. It defines different types of abortions such as spontaneous, induced, and therapeutic abortions. Therapeutic abortions may be indicated for maternal reasons like heart disease or cancer, or fetal reasons like anomalies incompatible with life. The document outlines diagnostic techniques used to detect fetal malformations. It notes that Cameroon's abortion law is restrictive but allows abortion if the mother's health is at serious risk or the fetus has anomalies incompatible with life.

1. Abortion and Bioethics.
Dr. Nana P. Njotang,
Senior Lecturer, FMBS, University
Yaounde I.
M1

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.

4. Definition.
• Termination pregnancy <28 weeks 0r <22weeks, birth
weight <900g or <500g.
• Spontaneous abortion, sub-classed into threatened,
inevitable, incomplete, complete and missed abortions.
• Induced/voluntary/unsafe abortions.
• Therapeutic abortions.

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.