Unsafe Abortion Dr Reza Nasr MD MRCOG DFFP

Unsafe Abortion Dr Reza Nasr MD MRCOG DFFP NAIGO Monthly Meeting 8 8 1393

Background & Definitions • • • Miscarriage Non-Viable intrauterine Pregnancy Viable Intrauterine Pregnancy Abortion Termination of Pregnancy PUL: Pregnancy of Unknown Location IUP & Extra-uterine ( Ectopic) IUP of uncertain Viability IUFD

Unsafe Abortion: Definition • 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. • Circumstances : before, during or after an abortion

Examples : • 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; • a 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.

• 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.

Unsafe abortions per 100 live births

Trend

Maternal Death • Globally, the proportion of maternal deaths due to unsafe abortion has remained close to 13% over time.

reliance on abortion can be greatly reduced when: • women can plan pregnancies through effective contraception; • counseling and services meet the unmet need for family planning, and appropriate method mix • of contraception is offered to all women, including both married and unmarried women; a • safe abortion services are available and accessible.

In the meantime ill-effects of unsafe abortion should be prevented by: • making safe abortions services available and accessible where abortion is not against the law; • ensuring that permitted reasons for abortion are supported by the national legislative process and health systems; • granting access to services for the management of complications arising from unsafe abortion; and • providing postabortion counselling and offering contraceptive services, which will also help to avoid repeat abortion.

Prevention of infective complications • The following regimens are suitable for peri-abortion antibiotic prophylaxis: • • azithromycin 1 g orally on the day of abortion plus metronidazole 1 g rectally or 800 mg orally prior to or at the time of abortion • OR • • doxycycline 100 mg orally twice daily for 7 days starting on the day of abortion, plus metronidazole 1 g rectally or 800 mg orally prior to or at the time of abortion • OR • Metronidazole 1 g rectally or 800 mg orally prior to or at the time of abortion for women who have tested negative for C. trachomatis infection.

Method (Surgical and Medical)

Cervical preparation should be considered in all cases. • misoprostol 400 micrograms administered vaginally 3 hours prior to surgery or sub-lin gually 2– 3 hours prior to surgery.

• Administration of cervical priming agents can be associated with painful cramps, bleeding and unexpected expulsions. Therefore, extending the duration of use beyond those recommended should be avoided.

• Medical abortion regimens using 200 mg oral mifepristone and misoprostol are effective and appropriate at any gestation.

• The following regimens are recommended for early medical abortion: mifepristone 200 mg orally followed 24– 48 hours later by misoprostol 800 micrograms given by the vaginal, buccal or sublingual route.

• Surgical evacuation of the uterus is not required routinely following medical abortion between 13 and 24 weeks of gestation. It should only be undertaken if there is clinical evidence that the abortion is incomplete.

Thank you