Safe abortion service and post abortion care: Understanding complications

Aim: To see if unsafe abortions are getting lesser after the establishment of comprehensive abortion care (CAC) Unit since March 2004. Methods: Retrospective study of women admitted with complication of abortions [induced (medically/criminal) or spontaneous] during the entire ten years period after the inception of post abortion care (PAC) Unit 2095 May -2007 April ); the last 3 years overlapping the service years of CAC Unit establishment. Result: CAC and PAC units both are using manual vacuum aspiration (MVA) to procure uterine evacuation. CAC clients in the last 3 years have reached to a little less than 10,000. This is close to MVA services provided in the PAC Unit in the last 10 years amounting to 11,519. But the number (n=3958) of service provided by the PAC Unit for a complete period of three years 2058-2060 (April 2001 April 2004) showed a slight increase to (n=4323) as the CAC Unit became functional during the 2061-2063 (15 April 20042007). The complications observed in PAC unit while providing MVA are much more than CAC unit (5.75%: 2%). But the nature of complication is much more serious in CAC Unit, 10 of them needing laparotomy for 20(0.02%) cases of uterine perforation. The induced abortion rate within the hospital, three years before and during CAC services is almost similar (4.07%: 4.34%). Seriousness of the problem has definitely reduced during recent 3 year’s period (Baisakh 2061-2063 Chaitra) i.e. 52: 34 except for an unfortunate rise in uterine perforation from 8 to 29 cases, 10 being from the CAC Unit. Conclusion: Though the number of complicated cases of induced abortion seeking hospitalization has not changed much after inception of CAC services in the recent three years, there is definitely a decline in the admission of more serious complicated cases of induced abortion in the recent years with unfortunate rise in number of cases of uterine perforation. end in complications needing hospitalized management. The World Health Organization defines unsafe abortion ‘as a procedure for terminating an unintended pregnancy carried out by people lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both’. Before legalization of abortion in Nepal, women were more likely to get admitted with the complication of clandestine abortion. For this reason Post Abortion Care (PAC) Unit was established way back in May 1995 Correspondence Sudha Thapa Senior Consultant and coordinator of CAC* , Senior Consultant and coordinator PAC Unit**, and Senior Consultant and Hospital Director*** Email: [email protected] N. J. Obstet. Gynaecol Vol. 2, No. 1, p. 44 49 May -June 2007