1. Surveillance of
Abortion
Under supervision:
Dr. Farah Asad Mansuri
Associate Professor & Head, Department of
Community Medicine , KM&DC

2. RESEARCHERS:
FAUZAN ALAM HASHMI
ZOHAIB AHMED
M. SALMAN GHAZNI
HAJI ISMAIL SIDDIQ
M. TAHA

3. CONTENTS:
INTRODUCTION
OBJECTIVES
MATERIAL & METHODS
RESULTS
CONCLUSION
ACKNOWLEDGEMENT
REFERENCES

4. 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.

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

6. 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.

7. • 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 %).

8. • 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

9. Objectives:
Objectives
Specific
General
the age, parity
category of
the frequency of INDUCED
and period of
abortion & method
AND SPONTANEOUS
gestation at which
of management
ABORTIONS REPORTED in
most abortions
the tertiary care teaching most prevalent.
are taking place
hospitals of Karachi

10. 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,

11. 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.

12. Results

13. 1. Frequency of abortion in different
hospitals
ASH17%
Civil
HOSPITAL
37%
LNH
14%
SGQH
32%

14. 2. Category of abortion
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
induc
sp sp
threat inevit misse
ed
septic
compl incom
termi ened able d
ete plete
nation
categoryof abortion 2.90% 61.50% 3.40% 2.80% 3.10% 25.20% 0.60%

15. • 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.

16. 3. Frequency of abortion related to
age
64.80
%
13.40 21.40
% %
0.4%
16-20 years
21-30years
31-40years
41-60years

17. 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.

18. 4. Frequency of abortion according to
parity:
primi , 0
parous
15.80%
grand multi
parous
18.20%
Multi
parous
66.10%

19. • 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.

20. 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.

21. 5. Number of previous abortion
0.2%
7
0.4%
6
0.4%
5
0.8%
4
2.2%
3
6.1%
2
21.9%
1
67.8%
0
0 10 20 30 40 50 60 70 80
PERCENTAGE

22. 6.Abortions related to age [p=0.012]
200
180
160
140
no previous
120
abortion
100
80
one previous
60
abortion
40
20
2 or more than
0
2 previous
abortions

23. 7. Abortion related to period of gestation
14% at
0
8 weeks
11.8%
8 weeks
at
51% at 12 weeks
12week
10 10 weeks
s
weeks

24. 8. Conduction of abortion
90%
80%
70%
60%
50%
40%
82%
30%
20%
3%
10%
15%
0%
DAI
DOCTOR
NONE

25. 9. Most common method of
management of abortion found:
Dialate , curette
Evacuation
& evacuation
14.8%
64.5%
Method
Vacuum Prostaglandins
aspiration induced
7.8% 1.1%

26. • 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.

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

28. • 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)

29. 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.

30. 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

31. • 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.

32. Thank you