abortion and post abortion care
TRANSCRIPT
Abortion and Post-abortion care
Abortion
• Introduction• Definition:• Classification - clinical, onset, legal• Magnitude - global, Africa, Ethiopia
- spontaneous, induced• Outcome and complications• Cost to the health system
Spontaneous abortion
• Mechanism and pathology• Risk factors– Age– Multiple pregnancy– Pregnancy interval– Gravidity– Previous abortion– Early menarche
Etiology
• Early Vs Late
• Fetal – Ovofetal – Aneuploidy, – Euploidy
Maternal
• Infections• Endocrine• Social drugs• IUCD• Radiation• Laparotomy• Aging gamets
• Chronic diseases• Immunological• Toxins• Malnutrition• Uterine defects• Trauma – iatrogenic• Paternal
Clinical features, Diagnosis
• Hx• P/E: general, abdomen, pelvic• Lab: depends on clinical state• Clinical types– Threatened - Inevitable– Incomplete - Complete– Missed - Recurrent, Habitual– Septic
Differential diagnosis
• Ectopic pregnancy• Molar pregnancy• AUB/HMB• Local causes• Urinary tract, GI tract bleeding
Induced abortion
• Therapeutic – medical reasons• Elective (voluntary) – on demand– Prochoice Vs Antichoice– Counseling– Worldwide, Africa– Ethiopia
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.
Post abortion care
• Definition: – Comprehensive, based on individual needs
• Justification/rationale• Unsafe abortion, consequences
PAC: five elements
• Community-service provider partnership• Counseling• Emergency treatment of incomplete abortion
and its complications• FP services• Linkage with other RH services
Consequences of unsafe abortion
Unsafe abortionUnsafe abortionUnsafe abortionUnsafe abortion
Social Economic
Maternal deathMedical,
psychological
• Unsafe abortion is a leading cause of maternal mortality:– 13% - worldwide– 17% - east Africa
Causes of Maternal Death, Ethiopia*
*Facility based, Ethiopia
Risk factors related to abortion mortality
• Age• General state of health• Gestational age• Method of termination• Technical competence• Availability and accessibility of facilities
The right to life: No woman should die from pregnancy and childbirth.