Care Taken During Abortion - An Overview

Motherhood is considered a new beginning in a woman’s life. The physical and psychological changes that take place during this period are enormous. Also, the joy of the upcoming baby is very special. But abortion in that situation may be considered a difficult life event. Abortion is considered a common medical intervention. About 73 million induced abortions take place all over the world each year. The rate is even higher in developing countries. Post-abortion, a woman goes through a series of physical and psychological changes. Different types of intervention, like medical and psychological counseling, are needed to support women during this period. As a result, it is well understood that abortion care is an integral part of medical treatment.

What Is Abortion?

Abortion is the termination of pregnancy at a time when the when the mother is in the 28th week of pregnancy, or its weight is less than 500 grams. Abortion can be of several types. A spontaneous abortion is often related to physical complications related to pregnancy. In induced abortions, termination of pregnancy is done either through medical intervention or by self-managed methods. Accidental abortions are those where the loss of pregnancy occurs suddenly due to some factors.

Spontaneous Abortion - It is also termed miscarriage and is characterized by the loss of pregnancy naturally before twenty weeks of gestation. The cause of spontaneous abortions are:

• Medical Conditions - Certain medical conditions like uncontrolled diabetes, uncontrolled hypertension, celiac disease, and autoimmune conditions, like antiphospholipid antibody syndrome, are responsible for this. Infectious conditions like vaginitis, HIV (human immunodeficiency virus) infection, syphilis, and malaria are also associated.

• Age Factors - Increased age (over 35 years) or too little age (below 18 years) is associated with an increased risk of miscarriage.

• Structural Anomalies of Genital Tract - Anatomical abnormalities related to the female genital tract increase the risk of pregnancy loss. Abnormalities like fibroids, adhesions, or uterine scarring are responsible for this.

• Genetic Factors - The presence of an extra chromosome or absence of one or more than one chromosome in the embryo is associated with miscarriage.

• Placental Problem - Placenta is the portion of the mother's body into which the embryo grows. This helps to protect the embryo and apply nutrition to the embryo. Several placental problems like placenta previa (abnormal positioning of the placenta which covers the opening of the uterus), placental abruption ( placenta separates from the uterine wall before birth), chorioamnionitis ( a type of placental infection), and placenta accrete (placenta is attached too deeply in the uterus) may cause miscarriage.

• Habits - Certain deleterious habits like smoking and alcohol consumption may cause miscarriage.

• Drug Factors - Several drugs like Diclofenac, Misoprostol, Natalizumab, and Ergotamine are associated with miscarriage.

• Accidental Factors - Accidental consumption of toxic metals like lead or toxic substances like pesticides are responsible for accidental miscarriage.

Induced Abortion - In induced abortion, termination of pregnancy is done either with the help of medication or with surgical intervention. The rate of induced abortion is very high. Every three out of ten pregnancies end in induced abortions. The types of induced abortions are:

• Medical Abortion - Consumption of medication outside the medical faculty is self-induced abortion. The safe period for such abortions is nine weeks of pregnancy or less. If the duration of pregnancy is more than nine weeks, it should be done under medical supervision.

• Surgical Abortion - Removal of the uterus surgically is known as surgical abortion. If the pregnancy lasts more than 12 weeks, surgical abortions are preferred to avert medical complications. In certain cases, surgical abortions safeguard the mother's life. This type of abortion is known as therapeutic abortion. The conditions required for therapeutic abortions are medication conditions that can be fatal to the mother's health, abnormal fetus (genetic or structural abnormality), and sudden medical treatment required to the mother, like chemotherapy.

What Is Abortion Care?

Any type of abortion can be challenging. Even elective abortion (abortion by the mother's choice) may cause medical complications after the procedure. According to data from the world health organization, 45 % of induced abortions done between the year 2010 to 2014 were unsafe. Popper medical screening before the abortion procedure and medical follow-up after the abortion process are necessary to overcome any adverse conditions. Also, psychological support is necessary for the mother during such situations. So abortion care must be divided into steps like pre-abortion care, post-abortion care, and medical consultation during pregnancy. The goal of abortion care are:

1. Protect the sexual and reproductive health rights of the individual.

2. Protect the law of the land and maintain legal transparency.

3. Prioritize the health of the mother.

4. Care of the mother post-abortion procedure.

What Is Medical Consultation During Pregnancy?

This is not related to abortion care, but medical consultation before pregnancy and during pregnancy can be life-saving. This helps to evaluate the prior medical condition of the mother, screening of the genital tract, and pregnancy education and planning. This step is very helpful in avoiding miscarriage, specifically in developing countries.

What Is Pre-Abortion Care?

Evaluation of several factors before the abortion procedure is known as pre-abortion care. This includes:

• Determination of Gestational Age - This is perhaps the most important stage of the abortion procedure. Gestational age determines the type of abortion suitable for the procedure and the medication needed.

• Ultrasound Scanning - Ultrasound scanning help to determine the fetal condition and the pregnancy condition. This is very helpful for surgical abortions or in conditions like ectopic pregnancy.

• Medical History - Proper medical history of the patient is necessary to avoid any medical complications. Necessary medical tests are also should be performed.

• Pre- Abortion Counseling - Pre-abortion counseling is one of one most important aspects of abortion care. Counselors should understand the reason for abortion. In the case of elective abortion procedures, any medico-legal angle must be ruled out. Patients should be educated about contraception procedures and sterilization methods also. In the case of therapeutic abortion, the counselor needs to discuss the issue with the patient and also with her family. The method of the abortion and potential complications after the procedure must be discussed with the patient. Above all, all the necessary consent should be taken before the procedure keeping the legal aspect of the issue in mind.

Conclusion:

Abortion can be induced or due to medical complications. Any type of abortion should be dealt with cautiously and empathetically. The probable complications of abortion must be discussed with the patients beforehand, and the patient’s consent should be taken. Proper medical evaluation before the procedure is also needed. During the whole process, the sociolegal aspect also should be considered. Moreover, psychological counseling of the patient is also needed.