Surveillance Of Abortion Symposium E97

Surveillance of Abortion

Under supervision:Dr. Farah Asad MansuriAssociate Professor & Head, Department of Community Medicine , KM&DC

RESEARCHERS:

FAUZAN ALAM HASHMIZOHAIB AHMEDM. SALMAN GHAZNIHAJI ISMAIL SIDDIQM. TAHA

CONTENTS:

INTRODUCTION OBJECTIVES MATERIAL & METHODS RESULTS CONCLUSION ACKNOWLEDGEMENT REFERENCES

INTRODUCTION:

•Induced abortion is one of the greatest human rights dilemmas of our time.

•The need for scientific and objective information on the matter is therefore imperative.

•Because unsafe abortion is a cause of maternal mortality & morbidity , measures of its incidence are also important for monitoring progress towards MILLENIUM DEVELOPMENT GOAL 5.

•Every year, approximately more than 210 million women throughout the world discover that they are pregnant.

According to a report published on 11th October 2007 by Guttmacher Institute Newyork, USA and World Health Organisation, Geneva, Switzerland:

•an estimated 42 million abortions were induced in 2003, compared with 46 million in 1995.

•The induced abortion rate in 2003 was 29 per 1000 women aged 15–44 years

•48% of all abortions worldwide were unsafe, and more than 97% of all unsafe abortions were in developing countries.

•Nearly 44% of these abortions were performed under illegal conditions.

▫share of illegal abortions was higher in the developing countries (54%)

•compared to the developed countries (9 % only).

•The corresponding share was even higher in the countries in the Southeast Asian region (60 %).

•It is observed that in Pakistan an estimated 890,000 induced abortion are annually

•These may often be in unsaved condition and at the hands of unskilled providers.

•In Pakistan, although the contraceptive prevalence rate has increased from 9% to 24%, yet majority of women is unaware of different contraceptive methods available

Objectives:

Objectives

General the frequency of INDUCED AND SPONTANEOUS

ABORTIONS REPORTED in the

tertiary care teaching hospitals

of Karachi

Specificcategory

of abortion

& method

of manage

ment most

prevalen

t.

the age, parity and period of gestation

at which most abortions are taking

place

Materials & Methods:

STUDY DESIGN:

• Descriptive study• 6 months Sentinel Surveillance.

Study was carried out in Obstetrics and Gynaecology Departments of four major tertiary care teaching hospitals of Karachi:

1. Abbasi Shaheed Hospital, 2. Civil Hospital Karachi units I II III, 3. Sind Government Qatar Hospital, from the public

sector 4. Liaquat National Hospital, from the private sector,

Data was collected from 1st January 2008 till 30th June 2008.

Structured questionnaire was filled from the records of above mentioned hospitals.

The sample came out to be a total of 650.

Results

1. Frequency of abortion in different hospitals

ASH17%

LNH 14%

SGQH 32%

Civil HOSPITAL 37%

2. Category of abortion

sp com-plete

sp in-com-plete

in-duced ter-

mina-tion

threatened

in-evitab

le

missed

septic

categoryof abortion

0.029 0.615 0.034 0.028 0.031 0.252 0.006

5.00%

15.00%

25.00%

35.00%

45.00%

55.00%

65.00%

• In 6 months of study in the 4 major teaching hospitals of Karachi, there were only 22 cases (3.4%) of induced termination of pregnancy.

•This is not linked harmonically to facts and figures which state that 890,000 induced abortions take place annually in Pakistan.

3. Frequency of abortion related to age

16-20 years21-30years

31-40years41-60years

13.40%

64.80%

21.40%

0.4%

since most of the cases we recorded were spontaneous abortions. The results were remarkable:•According to our study, most of the

spontaneous abortions (64.8%) have arisen from the age range 21-30 years followed by age range 31 – 40 years.

•More than 40 years of age and less than 20 years of cases were less.

•There was also a case found of age more than 50 years.

4. Frequency of abortion according to parity:

Multi

parous 66.10%

grand

multi

parous

18.20%

primi parous

15.80%

•11.1 % of the subjects had one child while 9.1%) 2 & 5.7% more than

•47.6% of the women who had the abortions previously have had a live birth and did not have a previous abortion.

MULTIPAROUS women were greatest in number (66.1%) in our study. •This is not in accordance with a study at

Hyderabad, Pakistan where 28.12% women were primigravidae and 59.37% were grand multigravidae

•while Saeed AG from Islamabad, Pakistan has reported 11.55% patients as primigravidae and 57.8% multigravidae.

5. Number of previous abortion

0

1

2

3

4

5

6

7

0 10 20 30 40 50 60 70 80

67.8%21.9%

6.1%2.2%

0.8%0.4%0.4%0.2%

PERCENTAGE

6.Abortions related to age [p=0.012]

16-20 years

20-30 years

30-40 years

more than 40

years

0

20

40

60

80

100

120

140

160

180

200

no previous abortionone previous abortion2 or more than 2 previ-ous abortions

7. Abortion related to period of gestation

14% at 8

weeks

11.8% at 12weeks

51% at 10 week

s

8 weeks12 weeks10 weeks

8. Conduction of abortion

DAIDOCTOR

NONE

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

3%15%

82%

9. Most common method of management of abortion found:

Dialate , curette & evacuation64.5%

Evacuation 14.8%

Vacuum aspiration 7.8%

Prostaglandins induced 1.1%

Method

•On analysis on category of abortion against method of abortion, (P< 0.03), majority of the cases were spontaneous incomplete abortion of whom D&E had been performed (271 cases)

•followed by missed abortion cases on which D&E had been performed (106 cases)

•Vacuum aspiration was also a frequent method of abortion in Spontaneous incomplete and Missed abortions.

•Hysterectomy and use of prostaglandins were used only in complicated cases.

•Complicated D&Es were also done under General anesthesia in operation theatre.

Reasons of abortion

In 99.4% of cases we could not detect any reason of abortion.

•The largest number of women was those, having fetal loss for the first time (67.8%), followed by women who previously had only 1 abortion (21.9%).

•The greatest number of women being those who were multiparous and had no previous abortion before (P< 0.0001)

Recommendations :•Induced Abortions should be legalized

in Pakistan, to prevent backstreet abortions and threatening the lives of women under the hands of unskilled personnel.

•Gynecologist must seriously take some measures to educate & guide women of child bearing age in our society by launching campaigns to plan & safely execute a pregnancy, to avoid spontaneous abortions.

Acknowledgements:

We are intensely indebted to the contributions of:

Professor Shershah Syed- Head Department of Obstetrics and Gynecology, Sindh Govt. Qatar Hospital.

Professor Azra Sultana- Head Gynecology Unit- 2, Abbasi Shaheed Hospital.

Professor Halima Hashmi- Head Department of Obstetrics and Gynecology, LNH

•Professor Ghufrana Memon- Head Department of Obstetrics and Gynecology, Civil Hospital Karachi.

•Dr. Rubina Izhar- Head Gynae Unit- 3, Abbasi Shaheed Hospital.

•All the Post Graduate trainees of Sindh Govt. Qatar Hospital, Abbasi Shaheed Hospital, Liaquat National Hospital& Civil hospital Karachi, who helped us a lot during the research.

Thank you