This document discusses abortion, including definitions, types, causes, and health effects. It defines abortion as the expulsion of the product of conception before 20 weeks of gestation or a fetus weighing less than 500g. There are two main types - spontaneous abortion (miscarriage) and induced abortion. Induced abortions can be medical/safe abortions or unsafe abortions. Unsafe abortions can lead to immediate complications like hemorrhage and infection as well as long term issues including infertility and psychological trauma. Prevention strategies include comprehensive reproductive health education and increasing access to family planning services.

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