Maternal morbidity and mortality; Association with unsafe abortion

ABSTRACT

To assess the demographic features of unsafe abortion and associated maternal morbidity and mortality, and availability of post abortion care. A Case-Series. The study was carried out in Gynae Unit-1 of Bahawal Victoria Hospital [BVH], Bahawalpur from 1st January 2009 to 31st December 2009. Patients admitted with complicated unsafe abortion were evaluated regarding age, parity, marital status, educational status, socio-economic status, indication of abortion, qualification of abortionist and method used for abortion, contraceptive usage, immediate complications and death rate in abortion seekers. Descriptive statistics were used for describing variable. 119 patients were admitted with unsafe abortion. The mean age was 28.5 years. 90.8% women were married, 59.6% multiparous, 21% got secondary and higher education, 62 belonged to poor socio-economic status. ln 72% cases unsafe abortion was done during 1st trimester and 80% of women had previous history of unsafe abortion, 95% approached unqualified / semi skilled abortion providers who used instrumentation in 53% cases. The most common reason for abortion was multiparity [48%], and poorsocio-economic status [19%], 0nly 26.5% were using some kind of contraception. Most common complications were continued ongoing haemorrhage [incomplete abortion in 44%], followed by septic complications in 25% of cases and trauma to urogenital tract [22%] which also involved gut in 6% of cases. 2.5% patients reached in very critical stage and could not survived. Post abortion care provided to all patients of which 22% managed conservatively and 78% managed surgically. Contraception services offered to all but 24% refused them totally. Unsafe abortion constitutes a major threat to health and lives of women. Most of them are multiparous, married at peak of their reproductive life and belong to poor economic status. The associated immediate morbidity is much higher than mortality in terms of continued haemorrhage, sepsis, and trauma. The study focused on the need of post abortion care and easy accessibility to contraception to improve quality of life.