Publication: Post legalisation challenge: minimizing complications of abortion
Date
2004
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
Abortion has been legalized in Nepal since September 2002 by 11th amendment to the Muluki Ain. The present study
was conducted in Paropakar Shree Panch Indra Rajya Laxmi Devi Maternity Hospital to assess the magnitude of
induced abortion, its causes and the types of complications, in the post legalization phase. Prospective descriptive
analyses of the patients who were admitted with history of induced abortion from 16 th Dec 2003 to 13th March 2004 was
carried out. A total of 305 cases of abortion complications were admitted during the three-month study period, which is
39.7% of the total gynaecological admissions (768). Of these 31 (10.25%) patients had history of induced abortion. Half
of the induced abortion cases (52%) were of age group 21-29 yrs and 42% had three or more children. 39% of the cases
had history of induced abortion at more than 12 weeks and almost half of the cases (48%) had history of family
planning. The most common reason for seeking abortion was too many children (59%) followed by illegitimate
pregnancy (16%). Twenty-one patients gave history of abortion being performed by doctors and the most common
method used was D&C (75%). 77% of cases presented as incomplete abortion and one case presented with uterine
perforation, bowel injury and peritonitis. Twenty patients had evacuation under sedation while five had manual vacuum
aspiration (MVA); one patient required laparatomy. In two third of the patients intravenous fluid and antibiotics were
used. Four patients required blood transfusion. Abortion complications constitute almost 40% of the total
gynaecological admissions. Ten percent of the abortion cases had history of induced abortion. Medical persons, mainly
doctors, performed most of the cases of induced abortion and D&C was the most commonly used method. However the
patients had faced various types of complications. Untrained provider, resulting in serious life threatening injuries,
performed more than a third of the cases of induced abortion at more than twelve weeks gestation. This points to the
need for improved monitoring of the quality of services provided, and adherence to the criteria set by the procedural
order.