This document discusses abortion and post-abortion care. It defines abortion and classifies the different types. It also discusses the magnitude of abortion globally and in Africa and Ethiopia. It then covers spontaneous abortion, including risk factors and potential causes. It discusses the clinical features and diagnosis of abortion. It defines post-abortion care and its five key elements. It notes that unsafe abortion is a major cause of maternal mortality worldwide and in East Africa.

1. Abortion and Post-abortion care

2. Abortion
• Introduction
• Definition:
• Classification - clinical, onset, legal
• Magnitude - global, Africa, Ethiopia
- spontaneous, induced
• Outcome and complications
• Cost to the health system

3. Spontaneous abortion
• Mechanism and pathology
• Risk factors
– Age
– Multiple pregnancy
– Pregnancy interval
– Gravidity
– Previous abortion
– Early menarche

4. Etiology
• Early Vs Late
• Fetal – Ovofetal
– Aneuploidy,
– Euploidy

5. Maternal
• Infections
• Endocrine
• Social drugs
• IUCD
• Radiation
• Laparotomy
• Aging gamets
• Chronic diseases
• Immunological
• Toxins
• Malnutrition
• Uterine defects
• Trauma – iatrogenic
• Paternal

6. Clinical features, Diagnosis
• Hx
• P/E: general, abdomen, pelvic
• Lab: depends on clinical state
• Clinical types
– Threatened - Inevitable
– Incomplete - Complete
– Missed - Recurrent, Habitual
– Septic

7. Differential diagnosis
• Ectopic pregnancy
• Molar pregnancy
• AUB/HMB
• Local causes
• Urinary tract, GI tract bleeding

8. Induced abortion
• Therapeutic – medical reasons
• Elective (voluntary) – on demand
– Prochoice Vs Antichoice
– Counseling
– Worldwide, Africa
– Ethiopia

12. Ethiopia
• Termination of pregnancy by a recognized medical institution
within the period permitted by the profession is not
punishable where:
– The pregnancy is a result of rape or incest; or
– The continuation of the pregnancy endangers the life of the mother or
the child or the health of the mother or where the birth of the child is
a risk to the life or health of the mother; or
– The fetus has an incurable and serious deformity; or
– The pregnant woman, owing to a physical or mental deficiency she
suffers from or her minority, is physically as well as mentally unfit to
bring up the child.

13. Post abortion care
• Definition:
– Comprehensive, based on individual needs
• Justification/rationale
• Unsafe abortion, consequences

15. PAC: five elements
• Community-service provider partnership
• Counseling
• Emergency treatment of incomplete abortion
and its complications
• FP services
• Linkage with other RH services

16. Consequences of unsafe
abortion
Social Economic
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Maternal death
Medical,
psychological

18. • Unsafe abortion is a leading cause of maternal
mortality:
– 13% - worldwide
– 17% - east Africa

19. Causes of Maternal Death, Ethiopia*
*Facility based, Ethiopia

21. Risk factors related to abortion
mortality
• Age
• General state of health
• Gestational age
• Method of termination
• Technical competence
• Availability and accessibility of facilities

22. The right to life: No woman should
die from pregnancy and childbirth.