Complications and Management of Unsafe Abortion

Objective: To determine the frequency of unsafe abortion and its morbidity and mortality in patients presenting at Lady Aitchison Hospital Lahore (KEMU Lahore). Study Design: Descriptive study. Place and Duration of study: Department of Obstetrics and Gynecology, Lady Aitchison Hospital Lahore, from 1st January 2006 to 31st December 2010. Patients and Methods: All patients with history of induced abortion were admitted. The particulars related to each case like age, marital status, parity, reason for requesting abortion, place and expertise of person carrying out the procedure and outcome were recorded. Once patient arrived in our unit detailed examination was done and relevant investigations sent. After primary resuscitation and optimization, the patients were managed according to their complications in collaboration with general surgical department. Results: 120 mostly young ladies with age range of 17 to 47 years and mean age of 30.76 years, presented with complications of induced abortion. 110 patients were married and 10 were single mothers. 30 patients (25%) were nullipara and remaining 90 (75%) were having 5 or more children. Only 14 out of 120 patients were booked cases, who underwent elective therapeutic medical termination of pregnancy (for foetal congenital anomalies in 10 cases and maternal grade III cardiac disease in 4 cases) They had no complication. 106 patients presented with induced and unsafe abortion. They were referred cases, and had multiple complications. 4 patients were brought dead and two patients died during pre-operative resuscitation. 3 patient died post operative due to septicemia. Out of remaining 100 patients, 12 (10%) were managed conservatively, 50 (50%) had re-evacuation and 38 (38%) underwent exploratory laparotomy. Ileal perforation was found in 11 cases. These were treated by primary repair and resection and anastomosis (4 cases each) and ileostomy in 3 cases. Sigmoid perforation was found in 5 cases and managed by distal end colostomy. Repair of uterine perforation only was done in 11 cases. Hysterectomy was performed in 11 patients. In 34 patients peritoneal toilet was also done. Overall mortality was 9.6% (10). Conclusions: Our study shows high morbidity and mortality associated with induced unsafe abortion in the form of prolonged hospital stay, multiple blood transfusions, laparotomies, hysterectomies that compromises the future fertility of young patients.