DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20212971

Outcome and complications of self-administration of over-the-counter abortion pills: an observational study in a tertiary care hospital of a medical college in New Delhi

Anjali Singh, Sruthi Bhaskaran, Anshuja Singla

Abstract


Background: Due to unrestricted free availability of abortion pills, despite of national policies, guidelines and medical termination of pregnancy (MTP) act, unsafe abortions by self-administration of these drugs for termination of unwanted pregnancies without prescription are becoming common in our country, leading to associated morbidity and mortality.

Methods: A prospective Observational study was done at Guru Teg Bahadur hospital, university college of medical sciences, New Delhi, from November 2019 to April 2020, in the department of gynecology and obstetrics, on women visiting the outpatient department and casualty department with the history of self-administration of medical termination pills without prescription. This study was done to study the outcome and complications occurring due to self-administration of over-the-counter abortion pills that are freely available in the market. 95 women were included in study and data was collected regarding age, education level, parity, presenting complaints, complications and their management. Descriptive analysis of the collected data was done.

Results: In this study 95 women were included 71.6% took pills before 8 weeks of gestation, 1% took in second trimester. 46.3% landed up in incomplete abortion and 33.68% needed surgical evacuation, 8.42% had ectopic out, 2.1% had scar site pregnancy and 7.36% needed laparotomy, 1.05% had rupture uterus followed by abortion pill intake while 1.05% suffered from acute kidney injury (AKI). There was no ICU admission nor any mortality.

Conclusions: There is urgent need of strict legislation to curtail this bad practice and free availability of over-the-counter abortion pills which leads to unexpected morbidity and mortality, such drugs should be given only by health care providers under supervision, there is need of community level awareness so as to impart knowledge regarding this problem.

 


Keywords


Abortion pills, Over the counter, Self-administration

Full Text:

PDF

References


Cunningham FG, Leveno KJ, Bloom SL, Haulh JC, Gilstrap LC, Wenstrom KD, editors. Abortion. Williams Textbook of Obstetrics, 24th ed. New York: McGraw-Hill. 2014;215-31.

World Health Organization. Unsafe abortion, authors. Global and Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality in 2003. Geneva: World Health Organization. 2007;5. Available at: http://apps.who.int/iris/bitstream/handle/10665/44529/9789241501118_eng.pdf;jsessionid=BE550AB599882C0EF486B92F7A06F5B8?sequence=1.

FOGSI focus on Medial abortion. FOGSI-ICOG-GCPR guidelines (online) 2011. Available at: www.issuu com/fogsi/does/medical abortion. Accessed on 20 Feb 2021.

World Health Organization. Safe abortion: technical and policy guidelines for health systems. 2012;1-7. Available at: www.apps.who.int/iris/bitstream/10665/709141/9789241548434 eng.pdf. Accessed on 20 Feb 2021.

Bygdeman MSM. Progesterone receptor blockage. Effect on uterine contractility and early pregnancy. Contraception. 1985;32:45-51.

Swahn ML, Bygdeman M. The effect of the anitprogestin RU 486 on uterine contractility and sensitivity to prostaglandin and oxytocin. BJOG. 1988;95(2):126-34.

The medical termination of pregnancy amendment act. 2002;62.

International Consensus Conference on Non-surgical (Medical) Abortion in Early First Trimester on Issues Related to Regimens and Service Delivery. Frequently asked clinical questions about medical abortion. Geneva: World Health Organization. 2006. Available at: https://apps.who.int/iris/bitstream/handle/10665/278968/9789241550406-eng.pdf

World Health Organization. Safe abortion: technical and policy guidelines for health systems. 2012;1-7. Available at: www.apps.who.int/iris/bitstream/10665/709141/9789241548434 eng.pdf. Accessed on 20 Feb 2021.

Kaur Sukhwinder B, Singh Sukhminder Jit B, Kaur Gangdeep G, Nirankar S, Anita S, Goraya SPS. Medical abortion: is it a blessing or curse for the developing nations? Srilanka J Obstet Gynaeol. 2011; 33:84–90.

Government of India. The Medical Termination of Pregnancy Rules (Amendment). 2003. Ministry of Health and Family Welfare. New Delhi: Department of Family Welfare; 2003. Available at: http://www.mohfw. nic.in/index1. Accessed on 2015 Jun 11.

Bajwa SK, Bajwa SJS, Ghai GK, Singh N, Singh A, Goraya SPS. Medical abortion: is it a blessing or curse for the developing nations? Sri Lanka J Obstet Gynaecol. 2011;33(3):84-90.

Thaker RV, Deliwala KJ, Shah PT. Self-medication of abortion pill: women’s Health in Jeopardy. NHL J Med Sci. 2014;3(1):26-31.

Maarit J, Maarit N, Satu S, Elina H, Mika G, Oskari H. Immediate adverse events after second trimester medical termination of pregnancy. Hum Reprod. 2011;26(4):927-32.

Courtney S, Mitchell C. Mifepristone in abortion care. Semin Reprod Med. 2005;23(1):82-90.

Goyal V. Uterine rupture in second trimester pregnancy termination in women with a prior caesarean delivery: a systematic review. Obstet Gynecol. 2009;113:1117-23.