SEPTIC/UNSAFE ABORTION: A PREVENTABLE TRAGEDY
Abstract
Background: Unsafe abortion is one of the greatest neglected problems of health care in developingcountries like Pakistan. In countries where abortions are restricted women have to resort toclandestine interventions to have an unwanted pregnancy terminated. The study was conducted tofind out the prevalence of septic induced abortion and the associated morbidity and mortality and tohighlight the measures to reduce it. Methods: This cross-sectional descriptive study was carried outin Obs/Gyn B Unit, Ayub Teaching Hospital, Abbottabad from January 2007 to December 2011.During this period all the patients presenting with pyrexia lower abdominal pain, vaginal bleeding,acute abdomen, septic or hypovolaemic shock after undergoing some sort of intervention forabortion outside the hospital were included. After thorough history, examination and detailedinvestigations including high vaginal and endocervical swabs for culture and sensitivity and pelvicultrasound supportive management was given followed by antibiotics, surgical evacuation of uterus/major laparotomy in collaboration with surgeon as required. Patients with DIC or multiple systeminvolvement were managed in High Dependency Unit (HDU) by multidisciplinary team. Results:During the study period out of a total 6,906 admissions 968 presented with spontaneous abortion.There were 110 cases (11.36%) of unsafe abortion, 56.4% presented with vaginal discharge, 34.5%with vaginal bleeding, 21.8% with acute abdomen, while 18.9% in shock and 6.8% with DIC. Fortynine percent patients used termination as a method of contraception. Mortality rate was 16.36%,leading cause being septicaemia. Conclusion: Death and severe morbidity from unsafe abortions andits complications is avoidable through health education, effective contraception, early informedrecognition and management of the problem once it occurs.Keywords: Abortion, unsafe, septic, DIC, PreventionReferences
Saultes TA, Devita D, Heiner JD. The back alley revisited:
sepsis after attempted self-induced abortion. West J Emerg
Med 2009;10:278–80.
Pazol K, Gamble SB, Parker WY, Cook DA, Zane SB,
Hamdan S. Abortion surveillance —United States,
MMWR Surveill Summ 2009;58(8):1–35.
McKenna T, O'Brien K. Case report: group B streptococcal
bacteremia and sacroiliitis after mid-trimester dilation and
evacuation. J Perinatol 2009;29(9):643–5.
Rana A, Pradhan N, Gurung G, Singh M. Induced septic
abortion: a major factor in maternal mortality and
morbidity. J Obstet Gynaecol Res 2004;30(1):3–8.
Hakim-Elahi E, Tovell HM, Burnhill MS. Complications of
first-trimester abortion: a report of 170,000 cases. Obstet
Gynecol 1990;76(1):129–35.
Stuart GS, Sheffield JS, Hill JB, McIntire DD, McElwee B,
Wendel GD. Morbidity that is associated with curettage for
the management of spontaneous and induced abortion in
women who are infected with HIV. Am J Obstet Gynecol
;191:993–7.
Stubblefield PG. First and second trimester abortion. In:
Nichols DH, (Ed). Gynecologic and Obstetric Surgery.
Mosby-Year Book; 1993.p. 1016–30.
Stubblefield PG. Pregnancy termination. In: Obstetrics:
Normal and Problem Pregnancies. 3rd ed. New York:
Churchill Livingstone; 1996:1249–76.
Stubblefield PG, Grimes DA. Septic abortion. N Engl J Med
;331:310–4.
Osazuwa H, Aziken M. Septic abortion: a review of social
and demographic characteristics. Arch Gynecol Obstet
;275:117–9.
Lohr PA. Surgical abortion in the second trimester. Reprod
Health Matters 2008;16(31 Suppl):151–61.
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