Senior House Officer, Maternity Hospital Thapathali

Abstract Abortion has been legalized in Nepal since September 2002 by 11 th amendment to the Muluki Ain. The present study was conducted in Paropakar Shree Panch Indra Rajya Laxmi Devi Maternity Hospital to assess the magnitude of induced abortion, its causes and the types of complications, in the post legalization phase. Prospective descriptive analyses of the patients who were admitted with history of induced abortion from 16 th Dec 2003 to 13 th March 2004 was carried out. A total of 305 cases of abortion complications were admitted during the three-month study period, which is 39.7% of the total gynaecological admissions (768). Of these 31 (10.25%) patients had history of induced abortion. Half of the induced abortion cases (52%) were of age group 21-29 yrs and 42% had three or more children. 39% of the cases had history of induced abortion at more than 12 weeks and almost half of the cases (48%) had history of family planning. The most common reason for seeking abortion was too many children (59%) followed by illegitimate pregnancy (16%). Twenty-one patients gave history of abortion being performed by doctors and the most common method used was D&C (75%). 77% of cases presented as incomplete abortion and one case presented with uterine perforation, bowel injury and peritonitis. Twenty patients had evacuation under sedation while five had manual vacuum aspiration (MVA); one patient required laparatomy. In two third of the patients intravenous fluid and antibiotics were used. Four patients required blood transfusion. Abortion complications constitute almost 40% of the total gynaecological admissions. Ten percent of the abortion cases had history of induced abortion. Medical persons, mainly doctors, performed most of the cases of induced abortion and D&C was the most commonly used method. However the patients had faced various types of complications. Untrained provider, resulting in serious life threatening injuries, performed more than a third of the cases of induced abortion at more than twelve weeks gestation. This points to the need for improved monitoring of the quality of services provided, and adherence to the criteria set by the procedural order. t the United Nations International Conference on Population and Development (ICPD) in Cairo in 1994, governments identified unsafe abortion as a public health problem. Worldwide 46 million or 22% of all pregnancy end in induced abortion 1 . Of these 20 million occur under unsafe condition. Each year an estimated 80,000 women die from complications of unsafe abortion accounting for 13% of global maternal mortality 2 . The rates at which women seek abortion are strikingly similar for women living in developed and developing countries 3 . However, the chances of receiving a safe abortion vary widely and are determined by a variety of socioeconomic, legal and cultural factors. When performed by trained providers in sanitary conditions, abortion is one of the safest medical procedures 4 . In our country, the recent legalization of abortion law has put forward Procedural Order, which has been formalized since December 2003.The law states that abortion is legal under certain conditions, following the rules and regulations laid by the Procedural Order. It demands that a trained and listed provider should provide abortion services, within the limits as set by the law. The present study was carried out to assess the magnitude of cases admitted with abortion complications, to analyze the cases of induced abortion and the types of complications of induced abortion. Falgun, 2060) with history of induced abortion. A total of thirty-one cases were admitted during the study period. These patients were interviewed and their management followed. Retrospective statistical data of abortion complications during the same time period in the previous year was taken from statistics department for comparison. Patients and Method