ABSTRACT

CORRESPONDING AUTHOR:
Dr. Kashif Shahnawaz,
Manhar Road, Chhoti Quazipura,
Dist -  Darbhanga, Bihar, PIN – 846004.
Email: kashif.shahnawaz98@gmail.com

ABSTRACT: INTRODUCTION: Septic abortion is a significant contributor to maternal morbidity and mortality. Termination of pregnancy, although a safe and easy procedure in trained hands, can produce catastrophic outcomes when performed by unauthorized or untrained people and in improper settings. OBJECTIVE: To find out the association of various socio-demographic factors with septic abortion. MATERIAL AND METHODS: This was a longitudinal study, conducted in the indoor of obstetrics & gynaecology department of R.M.C.H & R.C, Ghaziabad district of Uttar Pradesh from the period of Feb-2013 to April-2013, after selecting 100 septic abortion cases by simple randomization, who were admitted during the study period. Information of all these cases regarding their age, marital status, socio-economic status, literacy, parity and gestational age was obtained, and their association with septic abortion was studied accordingly. OBSERVATION: Out of the 100 cases of septic abortion studied, maximum percentage (66%) of the cases was seen from the age group of 26 to 35 years. Most of the cases (97%) were married, maximum (40%) were belonging from low socio-economic status group (Group-IV), maximum (60%) number of cases were illiterate, maximum (53%) number of cases belonged to women group having parity five and above, and maximum (86%) number of women were in the 1^st trimester of pregnancy at the time of abortion. CONCLUSION: Present study confirms that unsafe abortion is one of the greatest neglected healthcare problems in India and more so in rural India. So, there is the need to strengthen quality abortion services to reduce the maternal morbidity and mortality due to septic abortion.

KEYWORDS: Septic abortion, Socio-demographic factors, morbidity, mortality.

INTRODUCTION: Septic abortion is a significant contributor to maternal morbidity and mortality. Termination of pregnancy, although a safe and easy procedure in trained hands, can produce catastrophic outcomes when performed by unauthorized or untrained people and in improper settings. Septic abortion is a result of unsafe abortion which is defined by the WHO as a procedure for terminating an unwanted pregnancy, either by a person lacking the necessary skill or in an environment lacking the minimum medical standards or both.¹ Unsafe abortion causes colonization of the upper genital tract by micro-organisms following termination of pregnancy, usually before the age of viability. These can result from ascending infections from the lower genital tract or direct inoculation of micro-organisms from contaminated and poorly sterilized instruments, at the evacuation of the uterus in incomplete abortion or during unsafe abortion. Septic abortion is accompanied by significant morbidity, cost and maternal deaths. Of the over half a million maternal deaths that occur each year, globally,² it is estimated that one quarter to one third maybe a consequence of complications arising from unsafe abortions.^{3, 4} Septic abortion continues to be a major public health problem in developing countries of the world. Although abortion has been legal in India for more than four decades, access to safe services remains limited for most women. It has been estimated that nearly 90% of abortions in India are performed under potentially unsafe conditions in unapproved facilities, by providers ranging from qualified doctors to those without any training or qualifications.⁵ In India, each year about 1,25,000 women die from pregnancy related causes.⁶ At least 1/5^th of these deaths are caused by induced abortion, sepsis being one of the causes.⁷ In the majority of the cases, the infection occurs following illegal induced abortion, but can occur even after spontaneous abortion.

Various Socio-demographic factors are associated with high incidence of septic abortion cases in developing countries like India. Important among them are poverty, unavailability of legal abortion services, uncontrolled & unchecked growth of the quacks, pregnancies in unmarried girls, widows, strong preference for male child, etc. Viewed in this context, the present study was undertaken to evaluate the socio-demographic presentation of septic abortion, with special reference to age, marital status, socio-economic status, literacy, parity and gestational age.

OBJECTIVE: To find out the association of various socio-demographic factors with septic abortion.

MATERIALS AND METHODS:

Study-Design: Longitudinal Study

Study-Area: Indoor of obstetrics & gynecology department of R.M.C.H & R.C, Ghaziabad, U.P, India, in collaboration with the department of community medicine.

Study-Period: February-2013 to April-2013 (Three Months).

Sampling Technique: Simple Randomization

Sample Size: By selecting 100 Septic abortion cases admitted during the study period.

Inclusion Criteria: (i) Women having any sign of septic abortion.

(ii) Women agreed to follow the intervention protocol during the study period, for the collection of data.

Exclusion Criteria:  (i) Women who did not give consent.

(ii) Women not having any sign of septic abortion.

(iii) Women who were not available for giving information.

Study-Population: 100 women having signs of septic abortion in the study setting.

Study Method                : The present study was conducted after selecting 100 cases of septic abortion. All women having features of septic abortion and registered in the indoor for treatment were considered as study subjects. Diagnosis was made on the basis of per abdomen examination, per vaginal examination, investigations and per operative findings. Verbal consent was obtained from each women and a personal interview was carried out with the pre-designed questionnaire for collecting data. Confidentiality and privacy of the cases were maintained. Information regarding age, marital status, socio-economic status, literacy, parity and gestational age was obtained.

Study-Variables: The relation of septic abortion and few socio-demographic factors of the women, such as age, marital-status, socio-economic status, literacy, parity and gestational age were studied.

Statistical Analysis: All the data were entered into the SPSS package (Version-17). Association of the various risk factors of women with the septic abortion was assessed by applying ‘Z’ test and student ‘t’ test. The ‘Z’ test is applied for testing the difference of two proportions between two groups. Student ‘t’ test is applied for finding the significance between the difference of two means.

OBSERVATIONS: The relation of septic abortion to factors like age, marital status, socio-economic status, literacy, parity and gestational age were studied in the present research.

** Highly Significant n=Number of Cases

Out of the 100 cases studied, maximum percentage of cases (66%) were seen from the age group of 26 to 35 years, followed by other age groups, and minimum (3%) were seen after 40 years of age.

n=Number of Cases

Out of 100 cases studied the maximum number of cases (97%) was married, while only 2% cases were unmarried and one was widow.

n=Number of Cases

Out of 100 cases studied, maximum number of cases (40%) were belonged to low Socio-economic status group (Group-IV), while minimum number of cases (10%) were belonged to high socio-economic status group (Group-I).

** Highly Significant                       n=Number of Cases

Out of the 100 cases studied, maximum number of septic abortion cases were illiterate (60%) and significantly more in number than other literate groups.

n=Number of Cases

Out of the 100 cases studied, the percentage for the parity of the women underwent septic abortion were 6 (6%) in Group I and this group belonged to the primigravida. In Group II, there were 41 cases (i.e. 41%) and this group belonged to the women whose parity was 2-4 and mean parity was 3.2. In Group III, there were 53 cases (53%) and this group belonged to the women whose parity was 5->5 and mean parity was 5.8.

n=Number of Cases

Out of the 100 cases studied, the minimum gestational age of women underwent septic abortion was 10 days and maximum was 5 ½ months. Group I belonged to the women who underwent abortion in their 1^st trimester and this group comprised of 86 cases (86%). Group II belonged to the lower number of women who underwent abortion in their 2^nd trimester and this group comprised of only 14 cases (14%).

DISCUSSION: Septic abortion is a significant contributor to maternal mortality and morbidity, but is largely preventable. In our study, the majority of the patients (37%) were in the age group of 26-30 years, followed by the age group of 31-35 years (29%), findings similar to those of other studies.^{8, 9} However, Meenakshi et al, Jain V et al. and Bhattacharya et al.^10-12 found that three fourths of the women who had unsafe abortions were between 20-30 years of age. The reasons for this could be that we did not get any unmarried or teenaged pregnancies. Most of the patients of septic abortion in our study were married (97%). Studies by Meenakshi et al.¹⁰ & Sinha and Mishra,¹³ have also shown that septic abortion are found mostly in married women between 21-30 years of age. Majority of the patients (40%) belonged to low socio-economic group (Group-IV). Mukhopadhyaya and Das,¹⁴ also showed that 70% of their cases belonged to low socio-economic status, and a similar observation was also made by Das et al. (92.2%).¹⁵ After analyzing the literacy status, it was seen in our study that maximum number of septic abortion cases (60%) were illiterate. Bansal and Sharma, ¹⁶ also reported in their study that 64.6% were illiterate and 34.4% were literate. In our study, it was shown that out of all the cases of septic abortion, 6% were primiparas, 41% had parity two to four, and 53% cases had parity five and above. Sood et al¹⁷ found that 26.6% had parity less than 2.

CONCLUSION: Our present study confirms that unsafe abortion is one of the greatest neglected healthcare problems in India and more so in rural India, where lack of education and freely available quality abortion services led to very high maternal mortality and morbidity. All, including male members of the family need to be educated regarding the contraception and safe abortion, because the causes of unsafe abortion are rooted in a complex set of socio-demographic circumstances. Prompt and early diagnosis of any septic complications and prompt referral to tertiary centres would avoid serious consequences and will save many lives and limit morbidities. Although law, policy and women’s right are central to this issue, making abortions safe is above all a public health responsibility of governments.

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