Unsafe Abortion Post Abortion Care and Ectopic Pregnancy - PowerPoint PPT Presentation

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Unsafe Abortion Post Abortion Care and Ectopic Pregnancy

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Unsafe Abortion Post Abortion Care and Ectopic Pregnancy Definition of Unsafe Abortion A procedure for terminating an unwanted pregnancy either by persons lacking the ... – PowerPoint PPT presentation

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Title: Unsafe Abortion Post Abortion Care and Ectopic Pregnancy


1
Unsafe Abortion Post Abortion CareandEctopic
Pregnancy
2
Definition of Unsafe Abortion
  • A procedure for terminating an unwanted pregnancy
    either by persons lacking the necessary skills or
    in an environment lacking the minimal medical
    standards - or both.

3
Magnitude of the problem
  • 25 of all pregnancies worldwide end in an
    induced abortion, approximately 50 million each
    year.
  • Of these abortions 20 million are performed
    unsafely.
  • In Africa unsafe illegal abortions are 700 times
    more likely to lead to death than safe legal
    abortions in developed countries
  • Unsafe abortions are responsible for 65.000
    maternal deaths each year (13)
  • Due to religious, cultural and political
    barriers, abortion remain illegal in many
    developing countries

4
Unsafe Abortion
  • Typical complications from unsafe abortions (840
    cases from Ibadan, Nigeria, 1989)
  • Sepsis 86
  • Hemorrhage 35
  • Uterine perforations 16
  • Genital tract injury 10
  • Renal failure 0.4
  • Coma 0.4
  • Embolism 0.2
  • 59 (7) died because of complications

5
Unsafe Abortion
  • Long-term consequences
  • Pelvic inflammatory disease
  • Tubal occlusion
  • Ectopic pregnancy
  • Infertility
  • Chronic pelvic plain

6
Abortion Laws
  • Denmark
  • Every woman aged 18 and over has a right to
    pregnancy interruption in a public hospital at no
    cost to her without stating any reasons,
    providing she is resident in Denmark and the
    interruption is performed before the end of the
    12th week of gestation.

7
Abortion Laws
  • Tanzania
  • When Tanzania gained independence in 1961 it
    inherited a law based on the British legislation
    of 1861.
  • Illegal abortion carries a sentence up to 14
    years for the abortionist, seven years for the
    woman herself and three years for any person
    supplying drugs or instruments.
  • Although the law is very strict, prosecutions are
    rare

8
Effects of the introduction in Romania in
November 1966 of an anti abortion law, and
legalization of abortion in December 1989
9
  • In Tanzania it is estimated that more than half
    of the patients admitted at gynecolological ward
    attend because of complications to unsafe
    abortion.
  • Therefore...
  • All women in reproductive age (14-50 y) attending
    a health facility should have a
    pregnancy urine dipstick performed on
    admittance!!
  • If the pregnancy test is positive
    vital signs, abdominal and vaginal
    examinations are the absolute minimum
    examinations on admittance.
  • If signs of infection, excessive bleeding or in a
    critical condition
    MVA or DC should be
    carried out immediately!!

10
Post Abortion Care
  • Emergency treatment
  • Contraceptive counseling, STI and HIV evaluation
    and treatment.
  • Community involvement

11
Emergency Treatment
  • At sepsis or significant bleeding surgical
    abortion must be performed immediately!
  • Surgical abortion is part of basic emergency
    obstetric care and should be available at all
    health facilities
  • At sepsis antibiotics should be started during or
    after surgery ampicillin is only in therapeutic
    levels for 15-30 minutes and does not penetrate
    to the infected, dead pregnancy product.

12
Post Abortion Care
  • Surgical abortion
  • Vacuum Aspiration The cervix is dilated with a
    series of instruments. A tube is inserted into
    the uterus and connected to a strong vacuum. The
    embryo is removed by suction.
  • Dilatation and Curettage (D C) The cervix is
    dilated. An instrument with a blunt loop at the
    end is inserted into the uterus. The inside wall
    of the uterus is scraped.
  • Can be done in local analgesia only

13
Manual Vacuum Aspiration
14
Manual Vacuum Aspiration
15
Manual Vacuum Aspiration
16
Manual Vacuum Aspiration
17
Manual Vacuum Aspiration
18
Ectopic Pregnancy
  • Occurs in more than 1 in 100 pregancies
  • Risk Factors
  • Prior tubal infection
  • Prior Ectopic Pregnancy
  • Contraceptive intrauterine device

19
Ectopic Pregnancy
20
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21
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22
Ectopic Pregnancy - Treatment
  • Expectant 50 will end in tubal abortion. Can be
    considered if no clinical symptoms.
  • Medical treatment Metotrexate (cytostatic) or
    Mifegyne (ant-progesterone). Can be considered if
    only minor clinical symptoms and S-hCG lt 2000
  • Surgical treatment symptomatic extrauterine
    pregnancy.
  • In developing countries women diagnosed with
    ectopic pregnancies will have symptoms and will
    need surgery.
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