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Thursday, 8 June 2017


The definition of abortion is mired with controversy. What is generally accepted is that abortion is the termination of a pregnancy; before the developing fetus attains viability. While in the United States and other developed countries, viability is taken as 22 – 24 weeks, in Nigeria and some other developing countries, viability is put at 28 weeks gestation.
Unsafe abortion is abortion carried out by an unskilled individual and/or in an environment that does not meet the minimum medical standards. Spontaneous miscarriages in which sepsis (infection) or other complications occur are also classified as unsafe abortions. Some unsafe abortions are self induced, as individuals have been known to use objects such as straws, bicycle spokes, sticks, etc to procure an abortion!!
One in eight pregnancy related deaths is as a result of unsafe abortion. Of the approximately 205 million pregnancies worldwide per annum, 42 million end up as abortion, of which 20 million are unsafe abortions (98% in developing countries)
Unsafe abortion is a major cause of maternal mortality and morbidity. Unsafe abortion commonly occurs in countries with highly restrictive abortion laws where it is done as a clandestine procedure, either by trained medical practitioners (physicians, nurses, midwives) or traditional lay practitioners, chemists, etc.
Complications of Unsafe Abortions
1.Haemorrhage (Bleeding)- The most common complication. It can result in shock, coagulopathy (inability of blood to form clots which stops bleeding) and death. Bleeding may also be due to injury to the vagina, cervix, uterus, or adnexal vasculature (vessels close to the womb).
 2.Infection- This can be caused by retained products of the pregnancy, trauma, non-sterile(contaminated) techniques. Complications of infection include septic shock, Disseminated Intravascular Coagulopathy (which results in bleeding), blocked fallopian tubes and Asherman syndrome. Signs and symptoms include abdominal pain, foul smelling vaginal discharge, fever, pain on touching the womb (during sex or doctor’s examination).
3.Incomplete Abortion- Occurs when remnants of the pregnancy are still present in the womb generally presents with bleeding or infections.
 4.Trauma (Injury)- To the genital tract (vagina, cervix, etc), urinary system (bladder, urethra etc), or Intestines.
5.Chemical Burns or Drug Toxicity- Local damage to the vagina can lead to gynaetresia (tightening of the vagina) and dyspareunia (painful sexual intercourse). Some might be so badly burnt that they can no longer have sexual intercourse.
 7. Infertility- This is a late sequelae. Occurs as a result of the blocked fallopian tubes and Asherman syndrome (Asherman syndrome is diagnosed when there are scars within the womb as a result of the damage caused by the abortion procedure, with symptoms such as scanty menses, no menses or infertility).
Stop the bleeding when this occurs
Treat infections with antibiotics (preferably give the drugs through the veins).
A Laparoscopy (a minimal access surgery) or Laparotomy (Open surgery) to repair injuries extending deep inside the womb.
An Evacuation of retained products of conception is better performed under direct ultrasound scan guidance. This ensures you see exactly what you are doing and guides the doctor when to stop.
Infertility from blocked fallopian tubes can best be treated by having an IVF (In vitro fertilization) which is simply fertilization taking place outside the body, bypassing the tubes. However, for infertility as a result of Asherman's syndrome, the treatment will depend on the degree of adhesions (scarring). For mild to moderate adhesions a Hysteroscopy (which is a minimal access surgery) can be carried out to break the adhesions. In severe cases, surrogacy may be preferred (another woman carrying the pregnancy for the couple).
 1. Prevent unintended pregnancies: Abstinence is of course the best but condoms and other forms of contraception are equally effective in preventing unwanted pregnancies.
 2. Unfortunately, despite the illegality of abortions in Nigeria, in 2012 alone, a whopping 1.25 million abortions were performed, therefore provision of a high quality medicare including family planning counselling is important in such cases.
 3. Provision of high quality post abortion medicare.
#Gynescope hospital


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