ABSTRACT

Unsafe abortion is a major public health issue. At least 20 million women undergo unsafe abortion (abortions characterized by the lack or inadequacy of skills of the provider, hazardous techniques and unsanitary facilities or both) each year and some 67 000 women die as a result, with millions of others suffering chronic morbidities and disabilities.¹

¹ Abortion - a tabulation of available data on the frequency and mortality of unsafe abortion WHO/FHE/MSM/93.3

This practical guide is intended to assist health workers in preventing death and serious injury from abortion complications. The information is organized according to the sequence of decisions that must be made when women present with symptoms of abortion. The guide is divided according to the major complications of - shock; light, moderate and severe bleeding; intra-abdominal injury; sepsis; and incomplete abortion - in order to assist the clinician in identifying and treating the most urgent conditions first.

The guide stresses that any woman of reproductive age and experiencing symptoms of vaginal bleeding, cramping or lower abdominal pain and a possible history of amenorrhoea should be considered as a possible abortion patient. An accurate initial assessment and prompt action to stabilize the patient and begin treatment is essential.

The practical guide describes emergency abortion care activities by level of health care facility and staff. At the community level, staffed by workers with basic health training and traditional birth attendants, abortion care consists of recognition of signs and symptoms of abortion and complications together with timely referral to the formal health care system. At the health centre, simple physical and pelvic examination is possible together with resuscitation and preparation of the patient for transfer. If trained staff and appropriate equipment are available additional treatments such as antibiotic therapy, intravenous fluid replacement, oxytocin, uterine evacuation during the first trimester and analgesia and sedation should be provided. At the first referral level more complex procedures including uterine evacuation through the second trimester, blood transfusion, anaesthesia, laparotomy and treatment of most complication is possible. Severe complications such as bowel injury and failure, and severe sepsis may have to be referred to more specialised levels of care.

The text of each chapter is supported by a chart in decision tree form which illustrates the steps to assess and treat the patient.

A woman's fertility returns almost immediately after an abortion. Unless there are major complications from the abortion most methods of contraception may be started from the time of treatment. Considerations for specific post-abortion methods are listed in the guide.