MAFI

1. Abortion and Post-abortion care

2. Abortion
• Introduction
• Definition:
• Classification - clinical, onset, legal
• Magnitude - global, Africa, Ethiopia
- spontaneous, induced
• Outcome and complications
• Cost to the health system

3. Spontaneous abortion
• Mechanism and pathology
• Risk factors
– Age
– Multiple pregnancy
– Pregnancy interval
– Gravidity
– Previous abortion
– Early menarche

4. Etiology
• Early Vs Late
• Fetal – Ovofetal
– Aneuploidy,
– Euploidy

5. Maternal
• Infections
• Endocrine
• Social drugs
• IUCD
• Radiation
• Laparotomy
• Aging gamets
• Chronic diseases
• Immunological
• Toxins
• Malnutrition
• Uterine defects
• Trauma – iatrogenic
• Paternal

6. Clinical features, Diagnosis
• Hx
• P/E: general, abdomen, pelvic
• Lab: depends on clinical state
• Clinical types
– Threatened - Inevitable
– Incomplete - Complete
– Missed - Recurrent, Habitual
– Septic

7. Differential diagnosis
• Ectopic pregnancy
• Molar pregnancy
• AUB/HMB
• Local causes
• Urinary tract, GI tract bleeding

8. Induced abortion
• Therapeutic – medical reasons
• Elective (voluntary) – on demand
– Prochoice Vs Antichoice
– Counseling
– Worldwide, Africa
– Ethiopia

12. Ethiopia
• Termination of pregnancy by a recognized medical institution
within the period permitted by the profession is not
punishable where:
– The pregnancy is a result of rape or incest; or
– The continuation of the pregnancy endangers the life of the mother or
the child or the health of the mother or where the birth of the child is
a risk to the life or health of the mother; or
– The fetus has an incurable and serious deformity; or
– The pregnant woman, owing to a physical or mental deficiency she
suffers from or her minority, is physically as well as mentally unfit to
bring up the child.

13. Post abortion care
• Definition:
– Comprehensive, based on individual needs
• Justification/rationale
• Unsafe abortion, consequences

15. PAC: five elements
• Community-service provider partnership
• Counseling
• Emergency treatment of incomplete abortion
and its complications
• FP services
• Linkage with other RH services

16. Consequences of unsafe
abortion
Social Economic
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Maternal death
Medical,
psychological

18. • Unsafe abortion is a leading cause of maternal
mortality:
– 13% - worldwide
– 17% - east Africa

19. Causes of Maternal Death, Ethiopia*
*Facility based, Ethiopia

21. Risk factors related to abortion
mortality
• Age
• General state of health
• Gestational age
• Method of termination
• Technical competence
• Availability and accessibility of facilities

22. The right to life: No woman should
die from pregnancy and childbirth.