Septic Shock After Medical Abortion

Septic shock After Medical Abortion – Rare but Deadly

Many women with unplanned pregnancy are opting for medical abortion, in the belief (1) that they can avoid a surgical procedure with all its anticipated pain, injury and complications, and (2) that medical abortion being non-invasive is therefore safer.

Medical abortion has a more friendly profile, it has improved convenience, better privacy and less adverse effects. This is true for those with optimal response. To align with surgical abortion, optimal outcome is the complete expulsion of pregnancy contents within twelve hours after initiating medical abortion. This occurs in practice but in a minority.

Besides the unpredictable response with medical abortion, there are gathering reports of woman succumbing to severe infection. Toxic shock syndrome after medical abortion is rare, but it has high fatality. Clostridium species are responsible for most of the infections, follow by other common uro-genital organisms like Klebsiella pneumonia, Klebsiella aerogenes and Group A strep. The sepsis develops about ten days after medical abortion, suggesting delay clearance of pregnancy products predisposes.
To those who are considering medical abortion, it is crucial to maintain vaginal hygiene, complete the prescribed antibiotics and be vigilant of early sepsis.

Abortion and under-achievements

Abortion Mitigates Educational Under-achievements (in young women with unplanned pregnancy)

No one age group precludes unwanted pregnancy. For women below 21 years and have mis-timed pregnancies, many would opt to terminate them. The usual reasons are: disruption in their education (Torres & Forrest 1988), effect on career, inadequate finances and unstable relationships (Broen 2005).

In this millennium, young women are not prepared for motherhood. Finer found that this unpreparedness arises mainly from the interference to educational opportunities. The commercial value of education in each society differs according to the culture and economic development. In some communities, especially in East Asia, scholastic accomplishment makes or breaks a youngster’s career and future.

Earlier surveys in the late 1990s and early 2000s found indirect evidence of teenage abortion possibly benefiting subsequent life course outcomes. The common thread of teenage parenthood leading to educational under-achievement, poverty, welfare dependence, domestic violence and impaired relationships was repeatedly shown. Hofferth in 2001 reported teenage mothers completed two fewer years of schooling then mothers who first give birth after age thirty. Moore in 1993 wrote that lower ages at first birth were strongly associated with increasing risks of poverty for women at age twenty-seven. Adolescent mothers were more likely to become welfare dependent (Grindstaff 1988) and at increased risk for partner violence and relationship problems (Wiemann).

Does Abortion of Unwanted Teenage Pregnancies Reduce Adverse Life Course Outcomes?

In young women who had mis-timed pregnancies, those who seek abortion showed advantaged outcomes when compared with those who continued with the pregnancies. Zabin in 1989 found them more likely to complete high school and secured employment two years after.

The major reasons to abort unplanned pregnancies are to reduce the perceived adverse life course outcomes. In 2007, Fergusson studied abortion pattern among young women in Christchurch (New Zealand). He reported that those who seek abortion had relatively advantaged outcomes on educational achievement, income, avoidance of welfare dependence and partnership relationships. After analyzing the confounding factors, these differences were attributed to the advantaged social and educational standing of those who terminated the pregnancies. When due allowance was made for pre-pregnancy factors, only educational difference remained statistically significant.

Bailey in 2001 also highlighted that abortion may protect the educational opportunities in young women. Terminating the unplanned pregnancy mitigated the educational disadvantage associated with early pregnancy in adolescents. The statistics may illuminate certain benefits, but the abortion debate will rage on, dominated by the pro-life and pro-choice ideologies. Each camp stands on extreme views, neither willing to see or accept the counter argument.

Ordeal of Mid Trimester Pregnancy Termination

Why late abortion? The ordeal of mid trimester pregnancy termination

Most women chose to abort their unplanned pregnancy early in the pregnancy. Generally, an early abortion between seven to eight weeks of gestation is technically easier, less traumatic and more psychologically acceptable. Nevertheless, some women sought abortion in the mid trimester. 10-12% of abortions are performed between twelve and twenty-four weeks. In Singapore, a pregnancy may be legally terminated before the end of the twenty-fourth week of gestation.

Reasons for late abortion

Late abortion involves pregnancies that are still mostly unplanned. Some women struggled with the initial shock of the unplanned pregnancy. The partner and the woman may have difficulty in making the appropriate decision. In many instances, the woman may be left to handle the dilemma alone, shouldering an immense burden, and unable to gather advice and support from loved ones, who are often kept in the dark. There was this woman who saw me and wanted to continue with the pregnancy. She was determined to be a single mother. She overcame many mental hurdles and suffered through the phase of morning sickness. As the pregnancy progressed, she became fearful; being the sole breadwinner, she was uncertain if she could care for the baby and her ailing parents at the same time. She eventually aborted the pregnancy at twenty weeks.

There are those women who have not got a grip on what they want; and vacillated for weeks. The uncertainty may come from the anxiety over issues that may not be substantial, such as the fear of pain from needle injection! Younger women may not be psychologically prepared, and do not appreciate the intricacy in deciding, and they sometimes delay the decision into the second trimester.

Occasionally, a pregnant woman may be in denial and refused to accept the possibility of being pregnant even after months of delayed periods. When she saw the fetus moving inside her womb, she had no choice but to accept that her growing abdomen was not because she was “fat” but that she was pregnant.

Nevertheless, there are some late abortions that began as a planned pregnancy; a pregnancy that is desired, and the difficult decision to terminate the pregnancy was made reluctantly when the fetus is diagnosed to have a major anomaly that is not compatible with normal survival or development.

Performing Mid Trimester Pregnancy Termination

Mid trimester abortion is performed in two stages. The first stage uses medication to induce uterine contractions in order to expel the fetus, which by the second trimester will be more than six centimetres long. It usually takes several hours for this process to occur, and the duration will depend on the dosage and regimen used, as well as the woman’s response to the treatment. The contraction pain that accompanies the expulsion can be reduced by strong pain killers. The second stage is to remove the remaining pregnancy tissue from the womb, which is done under deep sedation or anaesthesia.

After Effect of Mid Trimester Abortion

In late abortion, the expulsion of a larger fetus and larger volume of pregnancy products, naturally suggests the possibility of more long term complication. The fear of subsequent infertility, and the risk of miscarriage and premature labor in future pregnancies have been extensively debated. To date, the jury is still out. When the abortion is inadequately performed and infection occurs, the woman may end up infertile. When the womb is inadvertently scarred by untrained personnel, future pregnancy may be difficult to maintain it to full-term delivery. Also, a woman who has a scarred uterus from preceding surgery to the womb has increased risk of womb rupture when she goes through the late abortion (just as she would be if she were to deliver a term baby).

In conclusion, late abortion should be avoided if possible. It should be regarded as a major procedure and the far reaching consequences have to be comprehended.