Unsafe abortion: the silent scourge

Authors

  • Sharadha Mallaiyan Department of Obstetrics and Gynecology, Thanjavur Medical College, Thanjavur, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20193566

Keywords:

Quacks, MTP services, MTP act, Rural India, Septic abortion, Unwanted pregnancies, Unsafe abortion

Abstract

Background: Unsafe abortions continue to cause maternal morbidity and mortality in developing countries. The practice of unsafe abortions by quacks needs to be checked. Our study aims to emphasize upon the unmet needs of medical termination pregnancies (MTP) services in rural India and to recognize the complications due to it and the efficient management of such cases at tertiary care center.

Methods: A two years retrospective study of septic abortions from December 2009 to November 2011.

Results: Among 1080 abortions reported, 44 were septic-4.07%. More commonly in the age group of >20years (81.9%). 77.3% of them were multiparous and 22.7% were nulligravidae, with an increased incidence of unmarried nulliparous pregnancies. Greater numbers occurred during 1st trimester (77.2% versus 22.7%), with 54.5%-grade I, 29.5%-grade II, 15.9% grade III in severity. Majority of cases were due to evacuation by quacks (72.7%). Among the 44 cases, emergency laparotomy was done for 5 cases of grade III severity. The mortality rates due to septic abortion were 6.25% (3) among the total of 48 maternal deaths.

Conclusions: Septic abortion is totally preventable. Majority of uneducated rural women are not aware of MTP services. The reproductive and child health (RCH) services should effectively reach the underprivileged population like slum dwellers and migrants.

References

Bashar M, Bhattacharya S, Singh A. Unsafe abortions in India: removing the Bottlenecks. Int J Med Public Health. 2018;8(1):42-4.

Ganatra B, Gerdts C, Rossier C, Johnson BR, Tunçalp Ö, Assifi A, et al. Global, regional, and sub regional classification of abortions by safety, 2010-14 estimates from a Bayesian hierarchical model. Lancet. 2017;390(10110):2372-81.

Guttmacher institute. Fact sheet: Induced, global incidence and trends, 2016. Available at: https://www.guttmacher.org/fact-sheet/induced-abortion-worldwide. Accessed on March 2018.

Nour NM. An Introduction to maternal mortality. Reviews in Ob Gyn. 2008;1(2):77-81.

Schorge J, Schaffer J, Halvorson L, Hoffman B, Bradshaw K. Williams Gynecology. 1st Ed. McGraw-Hill Companies; 2008.

Hiralal K. DC Dutta’s Textbook of Obstetrics. 7th Ed. Jaypee Brothers Medical Publishers; 2014.

Organització Mundial de la Salut, WHO, World Health Organization Staff, World Health Organization,.Safe Abortion: Technical and Policy Guidance for Health Systems, (World Health Organization; 2003:12.

David Eschenbach. Treating spontaneous and induced septic abortions. Obstet Gynecol. 2015;125(5):1042-8.

Government of India. Ministry of Health and Family Welfare Maternal Health Division. Available at: https://www.prsindia.org/uploads/media/draft/Draft%20Medical%20Termination%20of%20Pregnancy%20Amendment%20Bill%202014.pdf.

Shireen JJ, Shveta K, Shuchita M, Zavier TJ, Francis AJ, Acharya, R, et al. Feasibility of expanding the medication abortion provider base in India to include ayurvedic physicians and nurse. Int Perspect Sexual Reprod Health. 2012;38(3):133-42.

Jejeebhoy SJ, Kalyanwala S, Zavier AJ, Kumar R, Tank SJ, Jha AR. Can nurses perform manual vacuum aspiration (MVA) as safely and effectively as physicians? Evidence from India. Contraceptio. 2011;84(6):615-21.

Nimbalkar SM, Patel DS. The medical termination of pregnancy act: need to keep pace with technology. Indian J Med Ethics. 2018;096.

World Health Organization, Department of Reproductive Health and Research, Safe Abortion: Technical and Policy Guidance for Health Systems, (World Health Organization).2nd ed. 2012:68.

Krishnan S. MTP Amendment Bill, 2014: towards re-imagining abortion care. Indian J Med Ethics. 2015;12(1):43-6.

Das V, Agarwal A, Mishra A, Deshpande P. Septic abortion. J Obstet Gynecol India. 2006;56(3):236-9.

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Published

2019-07-26

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Original Research Articles