Abortion

Introduction

Abortion is expulsion from the mother’s uterus of a growing and developing embryo or fetus prior to the stage of viability (about 20 weeks), with fetal weight less than 50 g.
Abortion is one of the leading causes of maternal morbidity and mortality in most developing countries especially where it is illegal.
It may be:

  • Spontaneous- Occurring from natural causes or
  • Induced — Brought about purposefully by drugs or mechanical means

Types

The different types are:

  1. Complete— With complete expulsion or extraction from the mother of a fetus or embryo, and of any other products of conception
  2. Incomplete:- Parts of the products of conception have been expelled but some (usually the placenta) remain in the uterus.
  3. Unsafe – Termination of a pregnancy in circumstances where the law is restrictive
  4. Safe: When it is carried out in accordance with legal prescriptions.

In Nigeria, abortion is legal when it is
necessary to save the life of a woman.
When therefore a doctor determines that the life of a woman is at stake and therefore cannot continue with a pregnancy and therefore carries out an abortion, the abortion is a safe abortion.
Abortions done in other circumstances is unsafe.
Abortion can also be::

  • Solitary: – A single experience of an abortion or
  • Habitual – When a woman has had
    three or more consecutive, spontaneous abortions

Clinical features

Threatened abortion:

  • Slight vaginal bleeding is often the only symptom
  • The fetus is often alive and viable

Imminent/incipient/impending abortion:

  • Copious vaginal bleeding
  • Uterine contractions

Inevitable abortion:

  • The bleeding is more severe
  • The cervix has started to dilate with separation of the conceptus from the uterine bed
  • Rupture of the membranes in the presence of cervical dilatation in a pre-viable pregnancy

Ampulla/tubal abortion:

  • Abortion of pregnancy in the ampulla of the fallopian tube or the tube itself
  • Rupture of an oviduct, the seat of ectopic pregnancy
  • Extrusion of the products of pregnancy through the fimbriated end of the oviduct
  • Aborted ectopic pregnancy, the
    pregnancy having originated in the
    fallopian tube
  • Septic abortion: Complicated by fever, endometritis & parametritis

Differential diagnoses

  • Ectopic pregnancy, & Hydatidiform mole

Investigations

  • Pelvic ultrasound scan.
  • Pregnancy test will be necessary in cases of threatened abortion
    Microscopy, culture and sensitivity test of vaginal discharge
  • Urinalysis; urine microscopy, culture and sensitivity
  • Full Blood Count
  • Blood Group
  • HIV test, Hepatitis B and C antibodies

Complications

  • Endometritis
  • Parametritis
  • Peritonitis
  • Haemorrhage
  • HIV infection
  • Secondary infertility,
  • Perforation of the uterus and/or intestines rupture of the bladder

Treatment objectives

  • Restore hemostasis
  • Prevent/treat complications
  • provide health education, and
  • provide post-abortion family planning

Non-drug treatment

  • Nursing care
  • Psychological support
  • Personal hygiene

Drug treatment

  • Treat infection(s)
  • Replace fluid, electrolyte, and blood losses.
  • Complete incomplete abortion
  • Surgical correction of complications
  • Evacuation of retained products using manual vacuum aspiration (MVA) or
    misoprostol

Prevention

  • Promote personal and family understanding of basic reproductive health
  • Universal basic education
  • Girl child education
  • Moral instruction
  • Protect vulnerable groups (young females) from undue exposure to their male folks
    • At home
    • In school
    • Within peer groups
  • Legislation against street hawking for vulnerable groups
  • Provide access to Primary Health Care and referral to efficient and
    effective higher levels of care
  • Review existing laws on abortion with a view to promoting and protecting the overall wellbeing of mother and unborn child