Methods And Complications Of Induced Abortion

DEFINITION Abortion is termed the termination of pregnancy before the period of fetal viability usually taken in our environment to be the 28th week of gestation. Or By WHO; The expulsion or extraction from it’s mother of a fetus weighing 500gm or less.

Modern Methods of Abortion Medical – First trimester Antiprogestogens, Mifepristone(Ru486)600mg +prostaglandin-misoprostol Methotraxate+ Misoprostol

– Second trimester 2/3 of complications 50% of Deaths Hyper tonic saline or urea-intra/extra amniotic Prostaglandin E2,E1 or F2 alpha (Vaginally or Intra amniotic)

SURGICAL – – – – –

Suction Curettage (MVA) Surgical Curettage (D&C) Dilatation & Evacuation Hysterotomy & Hysterectomy Menstrual Regulation

COMPLICATIONS OF ABORTION Haemorrhage Infection Trauma– – –

Perforation Cervical incompetence Uterine synechiae

Psychological Effects Effect on Hospital Services

Burden of the problem  26-53 million induced abortion annually  40% in countries with restrictive laws  In Nigeria, Abortion rates 25 per 1000 women , 610,000 abortion per year. 40 % of maternal deaths  Netherlands – 5 per 1000 women.

PREDISPOSING FACTORS TO UNSAFE ABORTION Lack of adequate legislature and policies to regulate the procedure. Financial constraints on the part of the affected persons: -to raise children -to seek adequate contraception -Acquire appropriate education -Seek procedure under safe conditions -medical care for treatment of complications. Low illiteracy levels Unstable family set up Societal outlook and taboos Single parenthood Student pregnancies Religious condemnation of pregnancies etc Lack of information about complication of procedure, preventive measures prevalence of unsafe abortions.

Complications EARLY -septic abortion -septic shock -Injury -vagina, cervix, uterus -perforation of large /small bowels -Acute renal failure -Dissseminated intravascular coagulation -Incomplete abortion -Haemorrhage -pelvic abscesses -septic pelvic thrombophlebitis -Septic arthritis -Tetanus Adult respiratory distress syndrome

LATE -Chronic pelvic inflammatory disease -pelvic adhesions -chronic tubo-ovarian masses -chronic pelvic pain -tubal occlusion Ectopic Gestation Infertility Asherman’s syndrome -infertility -oligomenorrhoea /amenorrhoea -intrauterine adhensions Psychological factors -grief -regrets -dejection