Abortion and Bioethics.

Dr. Nana P. Njotang,Senior Lecturer, FMBS, University

Yaounde I.M1

Objectives.

• Define abortions.

• Name and discuss the different types of abortions.

• Name some maternal and foetal indications of

therapeutic abortion.

• Name some investigations required to confirm

diagnoses.

• Know the legal implications surrounding induced or

voluntary termination of pregnancy.

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Plan.• Definition.

• Classification of abortions.

Spontaneous

Induced /voluntary/ unsafe abortion.

Therapeutic abortion.

• Statistics on abortion.

• Diagnostic technique for foetal malformations.

• Indications for therapeutic abortions (foetal, maternal).

• Legal status of abortion in Cameroon.

• Perinatal medicine.

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Definition.

• Termination pregnancy <28 weeks 0r <22weeks, birth

weight <900g or <500g.

• Spontaneous abortion, sub-classed into threatened,

inevitable, incomplete, complete and missed abortions.

• Induced/voluntary/unsafe abortions.

• Therapeutic abortions.

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Statistics on abortion.• 40-50 million abortions occur each year.

• About 20 million are unsafe abortions.

• 13 % of maternal deaths are due to abortion related

complications.

• At the Central Maternity Yaounde 30-40% maternal

deaths due to abortion complication.

• WHO estimates that 68000 women die each year while

hundreds of thousand others suffer morbidity from

abortion complications.

• Estimated that 1:150 abortions cause maternal death

and 99% of this occurring in the developing countries.

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Statistics on abortion(1).• 60-70% of first trimester abortions, chromosomal

abnormalities.

• 12-15% of all abortions are spontaneous.

• Spontaneous abortion, therefore a regulatory

mechanism to reduce the number of malformed foetuses

that get to term.

• True prevalence of induced abortion, difficult to estimate.

• Cervical incompetence commonest cause of second

trimester abortions.

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Diagnostic techniques for foetal malformations.

• Chorionic villi sampling, carried out after the 9 weeks of pregnancy.- chromosome analysis. Risk: ? limb defects.

• Amniocentesis: carried out between 18-24 weeks of pregnancy. –chromosome analysis, biochemistry, hormone assay etc.

• HCG assay

• Ultrasonography, morphological studies, 20-24 weeks of pregnancy.

• Maternal alpha foeto-proteins, very high in neural tube defects.

• Maternal serology toxoplasmosis /rubella.

• Haemoglobin electrophoresis.Nana

Indications for therapeutic abortions.• Maternal causes:

Severe heart disease (New york class III/IV).

Malignancies (cervix, breast, etc).

Active rubella infection.

End stage diseases ? chances of having a pregnancy rare.

• Foetal causes:

Foetal malformation incompatible with extra-uterine life (anencephaly, severe neural tube defect, transposition of great vessels, multi-organ malformation- kidney, GIT, vertebral column).

Active rubella infection.

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Legal status of abortion in Cameroon.

• Law on abortion is restrictive.

• Abortion legalised when the health of the mother is at

serious risk, foetal malformation incompatible with extra-

uterine life or when pregnancy resulted from rape or

incest.

• This is found in article 337-339 of the penal code.

• Demand to terminate pregnancy must be signed by

treating physician and counter signed by two other

colleagues.

• Demand is addressed to the minister of public heath,

through the head of the health faciity.

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Perinatal medicine.

• New area of sub-specialisation in Obstetrics and

Gynaecology.

• Deals with prenatal diagnosis of some hereditary

diseases.

• Intra-uterine management, may include venopuncture,

intra-uterine transfusion and termination of pregnancy

where authorised by the law.

• Technology not available in our milieu today.

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Conclusion.• The law on abortion is restrictive.

• Abortion is punishable by law to the provider, the

aborted and sometimes the middle man.

• Unsafe abortion may lead to serious maternal morbidity

and mortality.

• However, the practice is still common in the developing

countries, for several reasons: law is restrictive, financial

constraint, fear of stigmatisation, protection of the

provider, lack of male support, fear of parents and then

desire to further education.

• It is worth emphasizing that abortion services be offered

women under the conditions authorised by the law.Nana