Termination of Pregnancy: All you should know about abortion

What do you know about abortion? That abortion is illegal or restricted in Nigeria does not mean we should not talk about it. After all, there are a lot of unsafe abortions carried out by quacks taking place out there. Several methods have been used to terminate pregnancies over the years. Deliberate termination of pregnancieshas been a subject of much debate with various views expressed from both religious,legal and cultural angles as below:

Therapeutic abortion : This refers to planned termination of pregnancy before 28 weeks for specific health indications. Indications or reasons for therapeutic abortion may be maternal or fetal distress. Maternal diseases such as severe cardiac disease, severe pulmonary tuberculosis, chronic renal diseases, some form of cancers, and rarely severe liver diseases. Fetal conditions include severe viral infections and dominant hereditary diseases like anencephaly (baby without brain). In Nigeria, termination of pregnancy due to the above conditions is legal and permitted.

Legal abortion: In many developed countries, abortion has a legal backing. In the UK for example, the Abortion Act of 1967 allowed the lawful termination of pregnancy but under certain criteria. In these countries, abortion services are provided in government and private hospitals.

Illegal abortion: In many developing countries,there are no abortion “acts” allowing lawful termination of pregnancy. In such countries, termination of unwanted pregnancies are described as illegal and criminal as both parties are liable to various terms of imprisonment if arrested. There is a high maternal morbidity and mortality associated with illegal (criminal) abortions.

Methods of termination of pregnancy

The methods of termination of pregnancy depend on the gestation (age of baby). Termination of pregnancy should be done at the earliest possible gestation, since morbidity and mortality associated with the procedure rises with the gestational age.

Termination can be done either surgically or medically. Prior to termination of unwanted pregnancy, the women should have adequate assessment and counseling. Assessment should include packed cell volume estimation, confirmation of pregnancy through pregancy test, and possible screening for infections. Medical history is taken to determine any contraindications to surgery or anaesthesia. You will be asked if you have any drug allergies or reactions. After these you will be counseled on the need for contraception.

Surgical Methods of abortion

1. Suction evacuation :Mostly called “evacuation” in Nigeria. It is the commonest method of termination of pregnancy. It is used commonly in both developed and developing countries. Sunction is obtained either by Karman syringe or by electrical pump. It is suitable for for a pregnancy less than 12 weeks. The need for cervical dilatation especially in later pregnancies causes pain during the procedure. The procedure may be done with or without anaesthesia. The use of paracervical block and analgesics (pethidine or fetanyl) allows cervical dilatation prior to insertion of the plastic suction curette. The cervix can be primed with prostaglandins (misprostol/cytotec) or laminaria tents to avoid cervical tear and cervical incompetence, which are common complications of mechanical dilatation.

2. Dilatation and Curettage(D & C):Dilatation of the cervix and evacuation of the uterus under anesthesia is easy done today. Here the products of conception are removed with sponge forceps followed by blunt curettage.

3. Hysterotomy: In this procedure, the contents of the uterus are evacuated through an abdominal approach. It is used only in exceptional cases. The procedure is usually under general anesthesia.

Medical methods of abortion

These methods are used for pregnancy over weeks as the the surgical risks in these circumstances are very high. This method of termination of pregnancy involve the use of misoprostol, mifepristone and methotrexate.

Sometimes, oxytocin is used to supplement the effect the action of prostagladins(misoprostone and mifeprostone) on the uterus.

I am going to discuss more of the use of misoprotol, mifepristone (RU-486) and methotrexate in the termination of pregnancy in the next publication.

READ ALSO: The debate over sex selection

Complications of termination of pregnancy

The complications of termination of pregnancy (TOP) include:
(1) haemorrhage (bleeding)
(2) incomplete abortion
(3)septic abortion (infection)
(4) cervical tear
(5) uterine perforation
(6)cervical incompetence and
(7) infertility due to tubal damage.

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