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JOURNAL OF COMMUNITY MEDICINE |
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INDIAN ASSOCIATION OF PREVENTIVE AND SOCIAL MEDICINE ORISSA CHAPTER |
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*P.G. Student, **O&G Specialist, *** Asst. Surgeon, **** Professor and Head
Department of Community Medicine, MKCG Medical College, Brahmapur |
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A.Patnaik, P.K.Gantayat, L.Patnaik, T.Sahu |
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Introduction Septic abortion is an infection of the uterus and its appendages following any abortion especially, illegally performed induced abortions1. Estimates of the number of abortions performed annually in India vary considerably, form 0.6 million to 6.7 million 2.
Septic abortion and subsequent complications is the cause of maternal death in 15% to 20% of cases3. Although abortion has been legal in India for more than three decades, access to safe services remains limited for most women. For example, it has been estimated that nearly 90% of abortions in India are performed under potentially unsafe conditions in upapproved facilities, by providers ranging from qualified doctors to those without any training or qualification4. Abortions are most commonly conducted by untrained personnel, dais, and quacks. Poverty, unavailability of legal abortion services and uncontrolled, unchecked growth of the quacks, both in urban and rural areas contribute to the high incidence of septic abortions. Social conditions like pregnancies in unmarried girls, widows, strong preference for male child etc. favour unsafe abortions leading to sepsis. Viewed in this context the present study is undertaken to evaluate the socio-clinical presentation of septic abortion with special reference to the mode of interference, presenting features and complications.
Material and Methods The present study was a hospital based cross-sectional study conducted during Aug.2004 to May 2006 Obstetrics and Gynecology (O and G) department of MKCG Medical College, Brahmapur.
All the abortion cases admitted to the in-patient department of O and G and diagnosed by Obstetricians as septic abortions were taken as study subjects. Data were collected on pre-designed schedule regarding the age, marital status, parity, socio economic status (SES), literacy, duration of gestation, type of interference and presenting features etc. The data were analysed with simple proportion in the Department of Community Medicine, MKCG Medical College, Brahmapur.
Results Total number of abortion cases admitted during study period was 688, out of which 42 were septic abortion cases. Thus proportion of septic abortion cases was 6.1 percent.
Table I Distribution of septic abortion cases as per to socio-cultural factors n=12
Factors Percentage
Age of mother < 20 19 20-30 57.3 >30 23.7
Residence Rural 71 Urban 29
Socio Economic Status Low 66.67 Middle 28.57 High 4.76
Literacy status Illiterate 57.14 Literate 42.86
Marital status Married 85.72 Unmarried 9.52 Widow 4.76
Parity Nulliparous 14.29 Para 1 and 2 38.1 3 and above 47.61
History of previous abortions Once 19.05 Twice or more 4.75
Table I shows 57.3% cases were in the age group of 20-30 years, 71% were from rural areas, 66.7% were from low socio-economic status, 57% were illiterate, 9.52% were unmarried and 4.76% widows. 14.2% were nullipara, and majority (47.6%) cases had parity three and above. History of previous abortion for one time was found in 19% of cases and for twice or more in only 4.7% of cases.
Table II Distribution of cases according to method of interference
Method of interference Percentage Dilation and Evacuation 28.6 Stick insertion 19 IM injection 14.3 Cervical application of chemical 14.3 Suction and Evacuation 9.5 Oral medication 9.5 Intra amniotic instillation 4.8
Most of the cases had history of active interference. Maximum cases (28.6%) were aborted by dilation and evacuation method, followed by stick insertion (19%). Suction and evacuation, IM injections, cervical application of chemicals, oral medication etc. were other methods of interventions.
Out of 42 cases, 95% cases had fever; 90.5% cases had foul smelling vaginal discharge. Some of them also presented with pain abdomen (86%), peritonitis (57%), shock etc.
Discussion In this study, it was found that 57.3% cases were in the age group of 20-30 years. It may be due to early marriage practice in this region and pregnancy in unmarried girls. Reddy et al observed that majority of septic abortion cases were in the age group of 21-30 years5.
Maximum cases (71%) were from rural areas which may be due to the fact that most of them don’t get facility of safe abortion services in the rural area and get aborted by untrained personnel. It was found that 66.7% were from low socio-economic status followed by 28.6% from middle SES. Similar pattern was reported by Sinder et al i.e. 70% came from low socio-economic group and 30% from middle6.
After analyzing the literacy status, it was seen that 57.14% were illiterate. Bansal and Sharma also reported in their study that 64.6% were illiterate and 34.4% were literate7.
It was found that 85.72% of cases were married, 9.52% cases were unmarried and 4.76% widows. Sharma JB et al found that 89.13% cases were married8.
Out of all cases, 14.2% were nulliparous, 38.1% had parity either one or two and 47.61% cases parity three and above. Sood et al found that 26.6% had parity less than 29.
19.05% of cases had history of previous abortion once only and 2 cases had history of more than one previous abortion.
It was found that 52.38% cases terminated in the first trimester and 47.62% terminated in the second trimester. Similarly Sharma et al reported that 54.34% cases terminated in first trimester and 45.66% cases terminated in second trimester8.
Dilation and evacuation is the commonest method of interference constitution (28.6%), followed by stick insertion (19%). Other methods used were suction and evacuation cervical application of chemicals and intra amniotic instillation. The termination pregnancy was conducted by quacks in 61.9% cases followed by paramedical workers (26.2%) and untrained dais (11.9%). Sood et al reported that termination method included instrumentation by untrained midwives (62%), foreign body insertion (7.5%) and dilation and curettage or suction by unqualified personnel9.
Fever was found to be in 95.2% cases, followed by foul smelling discharge in 90.5% cases and pain abdomen in 86% cases. In a study by Sharma JB et al it was seen that most common presentation was fever (82.6%) followed by generalized peritonitis (43.47%) and pelvic peritonitis (41.38%)8.
Conclusion It is unfortunate that even after all efforts of liberalization of MTP services since three decades, the mortality and morbidity due to septic abortion has not declined. Easy, unabated availability of quacks in the vicinity makes women vulnerable for unsafe abortion practices. Easy availability of MTP service free of cost to poor women along with increasing awareness can help in decreasing the number of septic abortion cases.
Reference 1. Rana A. Pradhan N, Gauranga G, Singh M. Induced abortion: A major factor in maternal mortality and morbidity. Journal of Obst. & Gynaec Res. Of India, 2004; 30(1): 3. 2. Khan ME et al, Abortion in India: current situation and future challenges, in: Pachauri S. ed., Implementing a Reproductive Health Agenda India: the Beginning, New Delhi: Population Council, 1998, pp. 507-529. 3. Malhotra S and Devi PK., Journal of Obst. & Gyn. Of India, 1979: 29:598. 4. Chhabra R and Nuna SC, abortion in India: An Overview, New Delhi: Veerendra Printers, 1994. 5. Reddy R, Bhupati S, Balusubramani., Journal of Obst. & Gyn. Of India, 1996; 46:73. 6. Sinder R and Konar H., Journal of Obst. & Gyn. Of India, 1981; 31:54. 7. Bansal MC and Sharma U., Journal of Obst. & Gyn. Of India, 1984; 35: 705-712. 8. Sharma JB, Manakfala V, Kumar A, Malhotra M. Complication and management of septic abortion: A five year study. Journal of Obst. & Gyn. Of India, 2001; 51(6): 74-76. 9. Sood M, Juneja Y, Goyal U. Maternal mortality and morbidity associated with clandestime abortions. Journal of Indian medical Association. 1995; 93(2): 77. |
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SOCIO-CLINICAL PROFILE OF SEPTIC ABORTION CASES A HOSPITAL BASED STUDY |
