"Abortion: Let’s Talk About It (Without the Drama)"

Abortion.
Why abortion? I'm taking this as my first topic for discussion because I was inspired by my patient and not just a random choice. My patient performed a DIY abortion and is now facing some serious complications. Let's dive into abortion and why safe abortion care is necessary.

Abortion is the expulsion or extraction of products of conception before the period of viability. In simple terms, it is when pregnancy ends before the baby can survive outside the womb.

What do we mean by viability? Viability is when a baby can survive on its own after birth with or without medical assistance. The period of time we can say a pregnancy is viable varies from country to country. For instance, in Ghana, a baby can survive outside the womb with adequate medical assistance from 28 weeks; in the USA and the UK, a baby can survive outside the womb from 22 to 24 weeks with adequate medical assistance instead of 38 to 40 completed weeks, which is the most appropriate time for a baby to survive outside the womb.

The World Health Organisation (WHO) defines abortion as: “The termination of pregnancy prior to 24 weeks of gestation or a foetus born weighing less than 500 grams, when it is unable to survive outside the mother’s womb.”

Another name for abortion is miscarriage. Most health professionals prefer to call it a miscarriage so that patients don't feel some way about it, especially if they did not do something in particular like using drugs to expel the baby but rather the abortion occurred spontaneously (unintentionally or naturally), to also reduce stigma, for cultural and religious sensitivity, and for legal and ethical consideration.

Epidemiology,
Abortion is said to occur in 15 to 20% of pregnancies. About 80% of abortions occur in the 1st trimester, which is the first 3 months or first 13 weeks of pregnancy.

How do we classify abortion?
Abortion is classified into Safety, Intent and Phase.

SAFETY

Safe abortion: is when the termination of the unwanted pregnancy is done by a skilled medical professional and in an environment with the basic medical standard for the abortion to be carried out.
Unsafe abortion is when the termination of the pregnancy is carried out by persons lacking the necessary medical skill and/or in an environment that lacks the basic medical standard for the abortion.

INTENT

Spontaneous: is when the termination of the pregnancy occurs on its own, that is, it occurs naturally, which could be due to reasons such as infections, chromosomal abnormalities, smoking, alcohol use, exposure to radiation, and many more.
Induced: is when, for medical, legal, or social reasons, a woman decides to end her pregnancy. The law on abortion in Ghana, PNDC Law 102, permits induced abortion under conditions like when the pregnancy is a result of rape, defilement, or incest; when the continuation of the pregnancy could result in the death of the mother; and when the baby in the womb has a serious physical abnormality or could develop one later.

PHASE

Threatened: earliest form of abortion. It is threatened because it is letting you know of its presence that if you plan on keeping the baby, then you have to do something about it.
Inevitable: Unavoidable abortion; the process of termination has started, and nothing can stop it.
Incomplete: some products and the baby have come out, but there is still some part in the womb.
Complete: All the products of conception are out, the baby,the fuild and others.
Missed: the baby has died in the womb, but the mother’s body has not expelled it.
Septic: when any other phase whether threatened, inevitable, complete or incomplete abortion is complicated by infection.
Recurrent: this is when 3 or more conservative spontaneous abortions occur with the same partner

Complications of abortion
A. Short-term Complications
Incomplete abortion
Infection
Bleeding
Septic shock
Injury to the genital tract and internal organs

B. Long-term Complications
Pelvic Inflammatory Disease
Chronic Pelvic Pain
Infertility
Ectopic Pregnancy
Psychological trauma
Social stigmatisation

Let us always remember that for whatever reason you want to perform an abortion and an induced one for that matter, it shouldn't be a solo adventure but rather with your healthcare practitioner.

fetus-baby-asks-for-help-is-removed-from-the-womb-with-gynecological-forceps-concept.jpg

Last tip: In Ghana, abortion is said to occur only if you are less than 28 weeks pregnant, but if you are more than 28 weeks pregnant, then that is delivery of the baby irrespective of the outcome, whether the baby died or lived.

In our next discussion, we will talk more on why a pregnant woman may need an abortion and how to perform a safe abortion and further expatiate complications and the management options available for abortion
Thank you for your time.

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