Abortion facts: Definition of abortion
Abortion is defined as termination of pregnancy before the age of viability of fetus, either spontaneous or induced, with or without expulsion of product of conception, the weight of product being less than 500 grams.
Abortions are of two types 1) Spontaneous abortion, 2) Induced abortion. Again induced abortion may be 1) Legal or Medical termination of pregnancy, 2) Illegal or criminal abortion
Abortion facts: When it is pregnancy strategy?
When spontaneous abortion occurs, it can’t be controlled by the person. And it occurs due to any cause of fetal abnormality, maternal incompatibility or incompatibility of the couple. It is considered as a pregnancy strategy and we encourage completing the process. This can give us information about a disease in the couple or the fetus. Thus it helps us plan next pregnancy in a manner that we can control the factors that has arisen in present one.
Performance of an induced abortion may be legal. It is called medical termination of pregnancy. According to the laws of most of countries (England, Scotland and Wales) abortions must be carried out in a hospital or a specialist licensed clinic and two doctors must agree that an abortion would cause less damage to a woman’s physical or mental health than continuing with the pregnancy. On the other hand the united States give a choice to mother to abort baby before 24 weeks. After 24 weeks state protects the right of a human to live. But in most third world up to 28 weeks medical termination is considered.
So we can say an abortion can be carried out during the first 24 weeks of pregnancy if following criteria are met:
- If it is only way to save the woman’s life, e.g. if the woman have severe heart disease, severe pre-eclampsia, end stage renal disease, rubella infection of mother with complications, HIV infection with complications, decompensated liver disease etc.
- In order to prevent grave permanent injury to the physical or mental health of the pregnant woman, e.g. in case of rape, incest, social stigma, unplanned pregnancies etc.
- If there are any chromosomal anomalies detected or any congenital anomalies detected or risk of serious physical or mental disabilities of child.
In these cases it is good to perform abortion before 12 weeks and ideally before 9 weeks if possible.
Abortion facts: statistics in United States
About 50% of pregnancies in America are unintended and about 30% to 40% of them tern to abortion. Unintended pregnancy rate increased slightly between 1994 and 2008. Unintended pregnancy was 55% more among poor and black women. But was 24% among women with high income. About 1.06 million abortions were performed in 2011. About 1.21 million abortions were performed in 2008. This shows a 13% decline in abortion rate. About 90% abortions occurred in the first 12 weeks of pregnancy.
We find that 58% abortions are occurring in women in their 20s. About 61% women who aborted have one or more previous children. About 56% abortion occurred in women who are unmarried and are not cohabiting. About 69% women who aborted are economically disadvantaged and religious affiliation was cause for about 73%.
Abortion facts: When you become a killer
Illegal or criminal abortion is one where you terminate pregnancy without causes stated above. In some countries people consider starting of human life from the embryo state. Some countries state consider fetus as human being after 24 weeks. So you become killer if you induce abortion after 24 weeks without any legal reason.
Abortion facts: Spontaneous abortion
Spontaneous abortion is one of the early pregnancy complications. It usually manifest as per vaginal bleeding ranging from mild to severe. It occurs for a number of causes stated in later part of this topic. It has some variants. Their treatment has inclination to evacuation of contents and bed rest. Let’s get idea about them.
Threatened abortion is a condition where the process of abortion started but progression is so less that from this state recovery is possible.
Inevitable abortion refers to an abortion where the process of abortion cannot be stopped and abortion always takes place there.
Complete abortion is the expulsion of all products of conception as a single mass at a time trough the vagina along with blood.
Incomplete abortion is the expulsion of some of the products of conception and hence requires evacuation of rest product of conception.
Missed abortion is the abortion where the embryo or fetus dies and retained in uterus for a variable period. It is similar to intrauterine death but before viability.
Septic abortion is a condition where there is infection of the uterus and sometimes infection of surrounding structures occurs.
Abortion facts: causes of spontaneous abortion
- Morphological and Genetic Abnormalities
- Maternal Infections
- Endocrine disorders and hypertensive disorders
- Uterine Defects
- Immunologic Disorders
- Emotional Disturbances
- Toxic Factors
Abortion facts: symptoms of spontaneous abortion
- Lower abdominal pain, supra pubic pain or uterine cramping
- Per vaginal bleeding ranging from spotting to severe bleeding
- Dilatation of cervical OS
- Expulsion of fleshy mass either complete or partial
- Retrogression of symptoms and signs of pregnancy
Abortion facts: Complications of abortion
Hemorrhage during or following abortion is the earliest complication and it may be life threatening. More blood loss found if the woman experience abortion at a later week of gestation. When you induce abortions you not only kill a human but also endanger your own life. Septic abortion is a grave life threatening complication of induced abortion, which may invite DIC and embolism at times. On the other hand, infertility may occur due to intrauterine adhesion. Perforation of the uterine wall may occur spontaneously or during evacuation and curettage procedure and may be accompanied by injury to the bowel, bladder and may form fistulas. Every abortion even abortions at very early weeks have a significant bad effect on the family. As most of these losses are unexpected creates grief and sometimes feeling of guilt. Every abortion is associated with tragedy but they have separate ways to react. The health workers should respond to them in time to support them.
Abortion facts: Treatment of spontaneous abortion
A complete history taking, meticulous examination including general physical and systemic examination with per vaginal examination if indicated should be done. Only an ultra sonogram can decide the state of abortion, gestational sac and product of conception. In case of septic abortion blood culture and high vaginal swab culture should be done. Investigations should include a complete blood count, blood typing, cervical cultures, blood sugar, endocrine parameters, auto immune antibody test, karyotyping and so on to determine cause of abortion.
In case of threatened abortion bed rest and pelvic rest are recommended. Sometimes progesterone is added. Serial ultra sonograms are done to be sure that abortion had not been taken place. If inevitable or incomplete abortion occurs evacuation of the uterus by a surgical method is the only treatment option. Dilatation and curettage is also done in missed abortion and abortion which bleed severely. Coagulation profiles are at times done in missed abortion. If coagulation disorder occurs coagulation factors are given. If complete abortion occurs, the patient should be observed for further bleeding and if she does not bleed rest is only treatment given to her. The products of conception passed should be examined to know it is complete or not. All Rh negative mother with partner Rh positive should receive an intramuscular immunoglobulin 50 microgram of anti-D within 72 hours of abortion. When uterine perforation is suspected operation ranging from peritoneal toileting to hysterectomy may be needed.
Abortion facts: Prevention of spontaneous abortion
Some spontaneous abortion can be prevented by early obstetric care. Adequate treatment of maternal disorders such as diabetes, hypertension, immunological disorders etc can prevent some abortions. Protection of pregnant women from environmental hazards like toxins, smoking, alcoholism and exposure to infectious diseases is needed to prevent some spontaneous abortions.