Abortion and its

consequences

Mahad Ali
MPH-RH
 Definition 

 Abortion can defined as termination of

pregnancy before 28 weeks of gestation or
viability. The current WHO definition is
termination of pregnancy before 22 wks or
when the fetus weight is 500 g or less.
This may be spontaneous or induced.
Types of abortion. (spontaneous)

 Threatened abortion
 Inevitable abortion
 Incomplete abortion
 Complete abortion
 Missed abortion
 Habitual abortion
 Induced abortion
 Abortion without cervical dilatation
 Abortion with cervical dilatation but with out
expulsion of products of conception( including
amniotic fluids
 Abortion with partial expulsion of conceptus
materials
 Abortion with complete expulsion of conceptus
material
 Missed abortion when a dead fetus retained in
the uterus at least another one month
 Habitual or recurrent abortion is diagnosed if
there is three or more consecutives
spontaneous expulsion of conceptus
 Threatened abortion

 Threatened abortion Presents with: -

cramping/lower abdominal pain
 -light PV bleeding
 O/E -soft uterus
 -closed cervix
 Inevitable abortion

 Inevitable abortion Presents with: -Cramping/

lower abdominal pain
 -heavy PV bleeding
 O/E -tender uterus
 -dilated cervix
 -Product of conception (POC) often felt through
the cervical os
 Incomplete abortion

 Incomplete abortion Presents with: -painful

uterine contractions
 -heavy bleeding
 O/E -uterus smaller than dates
 -dilated cervix
 -partial expulsion of POC
 Complete abortion:

 Complete abortion Presents with: -History

of heavy PV bleeding followed by
expulsion of POC then light bleeding.
 O/E -uterus smaller than dates
 -closed cervix.
 Missed abortion:

 Missed abortion The embryo/fetus dies but

doesn’t get expelled from the uterus.
Patient presents with slow progressive
bleeding followed by cessation of
pregnancy symptoms. Examination
reveals a firm uterus which is smaller and
a closed cervix.
 Induced abortion

 Induced abortion– usually done when the

pregnancy is unwanted/unplanned or when it
endangers the life of the woman. Can be done
surgically or medically depending on the GA,
skills and availability of appropriate equipment.
Unsafe abortion is performed either by persons
lacking necessary skills or in an environment
lacking minimal medical standards or both
usually ending in septic abortion.
 Causes of abortion

 Causes of abortion Genetical/chromosomal

 malformation of the zygote (eg molar preg)
Immunological factors
 Infections (TORCHES, malaria, HIV, genital tract
infections)
 Uterine anomalies (septate uterus, bicornuate uterus,
unicornuate uterus,
 cervical incompetence)
 General disease of the mother (diabetes, hypertension,
cardiac) Endocrine disorders Others; trauma, drugs,
emotional disturbance, etc. In the majority cause is
unknown.
 Complications of abortion
 Severe bleeding
 anemia
 shock
 renal failure
 Sepsis
 -septicaemia
 -PID
 -infertility
 -ectopic preg.
 Depression-marital disharmony
 Perforation of pelvic organs-peritonitis.
 Unsafe Abortion
 WHO defines unsafe abortion as a procedure for
terminating an unintended pregnancy carried out
either by persons lacking the necessary skills or
in an environment that does not conform to
minimal medical standards, or both.
 While the definition seems to be linked to the
process, characteristics of an unsafe abortion
touch on inappropriate circumstances before,
during or after an abortion.
The following conditions typically characterize
an unsafe abortion

 no pre-abortion counseling and advice;

 abortion is induced by an unskilled provider,
frequently in unhygienic conditions, or by a
health
 practitioner outside official/adequate health
facilities;

 abortion is provoked by insertion of an object

into the uterus by the woman herself or by a
traditional practitioner, or by a violent abdominal
massage
 medical abortion is prescribed incorrectly
or medication is issued by a pharmacist
with no or inadequate instructions and no
follow-up;

 abortion is self-induced by ingestion of

traditional medication or hazardous
substances.
 Further hazardous features of
unsafe abortion are
 the lack of immediate intervention if severe
bleeding or other emergency develops during
the procedure;

 failure to provide post abortion check-up and

care, including no contraceptive counseling to
prevent repeat abortion;

 the reluctance of a woman to seek timely

medical care in case of complications because
of legal restrictions and social and cultural
beliefs linked to induced abortion
 Magnitude of the problem

 21.6 million women experience an unsafe

abortion worldwide each year; 18.5 million
of these occur in developing countries
 47 000 women die from complications of
unsafe abortion each year.
 Deaths due to unsafe abortion remain
close to 13% of all maternal deaths
 Facts on Induced Abortion
Worldwide
 After declining substantially between 1995 and
2003, the worldwide abortion rate stalled
between 2003 and 2008.
 • Between 1995 and 2003, the abortion rate (the
number of abortions per 1,000 women of
childbearing age—i.e., those aged 15–49) for
the world overall dropped from 35 to 29. It
remained virtually unchanged, at 28, in 2008.
 • Nearly half of all abortions worldwide are
unsafe, and nearly all unsafe abortions (98%)
occur in developing countries. In the developing
world, 56% of all abortions are unsafe,
compared with just 6% in the developed world.
 Consequence of unsafe abortion
 Unsafe abortion is a significant cause of ill-
health among women in the developing world.
Estimates for 2005 indicate that 8.5 million
women annually experience complications from
unsafe abortion that require medical attention,
and three million do not receive the care they
need.
• Treating medical complications from unsafe
abortion places a significant financial burden on
public health care systems in the developing
world. According to a 2009 study, the minimum
annual estimated cost of providing post abortion
care in the developing world is $341 million.
 In developing countries, poor women have the least
access to family planning services and the fewest
resources to pay for safe abortion procedures; they are
also the most likely to experience complications related
to unsafe abortion.
 Unsafe abortion has significant negative consequences
beyond its immediate effects on women’s health. For
example, complications from unsafe abortion may
reduce women’s productivity, increasing the economic
burden on poor families; cause maternal deaths that
leave children motherless; cause long-term health
problems, such as infertility; and result in considerable
costs to already struggling public health systems.
 UNINTENDED PREGNANCY: THE ROOT OF
ABORTION

 The uptake of modern contraceptive methods

worldwide has slowed in recent years, from an
increase of 0.6 percentage points per year in
1990–1999 to an increase of only 0.1
percentage points per year in 2000–2009. In
Africa, the annual increase in modern
contraceptive use fell from 0.8 percentage points
in 1990–1999 to 0.2 percentage points in 2000–
2009.
 • An estimated 215 million women in the
developing world have an unmet need for
modern contraceptives, meaning they want to
avoid a pregnancy but are using a low-efficacy
traditional family planning method or no method
 Some 82% of unintended pregnancies in
developing countries occur among women who
have an unmet need for modern contraception.
• In the developing world, women’s reasons for not
using contraceptives most commonly include
concerns about possible side-effects, the belief
that they are not at risk of getting pregnant, poor
access to family planning, and their partners’
opposition to contraception.
• Reducing unmet need for modern contraception
is an effective way to prevent unintended
pregnancies, abortions and unplanned births