m

 



 
 
m

m

 

‡ Technically, this applies to any pregnancy
that ends before 24 weeks for any cause.
‡ The baby is capable of independent life
from 24 weeks, but the pregnancy should
last for 40 weeks.
‡ Mothers who lose a pregnancy do not like
the term abortion. When pregnancy ends
spontaneously before 24 weeks, it is
usually called a ³miscarriage´.
O
TS T MIS
I 

‡ It is very common, occurring in 15 ± 20%

of all recognised pregnancies.
‡ 1,000 per year in the island of Penang.
‡ Most occur between 6 and 10 weeks of
gestation.
‡ 60% due to chromosome abnormalities of
the fetus, most occurring at the time of
fertilisation.
K  M I  O TI

     




!" #
 ! 

$%

 

‡ Very contentious subject.

‡ Most people have strong opinion.

 O
TS T TI
‡
ontroversy not likely to stop soon.
‡ bortion has been practised for thousands of
years.
‡ It was favoured by reek philosophers, such as
Hippocrates ± (Oather of medicine).
‡ World wide estimate 42 million abortions per
year.
‡ 70,000 women die from unsafe abortions every
year, mostly in the developing world.
‡ It is impossible to stop women having abortions,
even if it is hard to get or illegal.
 TI I TH 
.

‡ asy access to abortion.

‡ 45% women have an abortion during their
reproductive life.
‡ Most done by choice, but some because
of fetal abnormality.
‡ Techniques-- STP (suction termination of
Techniques
pregnancy) or medical.
 TI I IK .

‡ Very difficult access to abortion.

‡ Most travel to ngland if abortion is
desired.
‡ 13% of women have an abortion during
reproductive life.
 TI I M K SI .

‡ o accurate statistics available,

but probably similar to Ireland.
 
 
&
 
 '  

&() &)&()
‡ Safer: Kess Infection ‡ eligious, ethical
Kess damage objections
to uterus
‡ pportunity for screening ‡ May be used instead of
for venereal disease contraception
‡ Kess unwanted children,
less future social
problems
 '
 $

‡ Oollowed 
rules up to Merdeka 1957.

‡ Kittle change since, although 

introduced liberal abortion in 1967.

 )"**$ '
 $

‡ octor may perform abortion (with consent) to

save woman¶s life or protect her mental or
physical health.
‡ sually two medical opinions are obtained.
‡ bortion may be done legally if pregnancy
follows rape.
‡ The law does T allow for abortion because
the baby is abnormal or handicapped, or on
woman¶s request.
‡ Many Malaysian doctors interpret law at
very edge.
 s"
+,,-

overnment / octors:

³ bortion laws in Malaysia do not need to be

changed´.
Why do women have abortions?
  
.

‡ Health ‡ conomics
‡ ge ‡ Psychological
‡ Timing & convenience problems
‡ Too many children ‡ Wrong father
‡ bnormal baby ‡ ape

tc., etc..
‡ very woman who has an abortion will
always question her own motives.

‡ o woman undertakes an abortion lightly.

‡ on--directional counselling is essential.

on
   

Most have ultrasound scan first:-
first:-

‡ To confirm pregnancy, its site and

apparent normality.
‡ To confirm the gestation.
‡ Methods used-
used- suction termination (TP)
or evacuation (used up to about 16 weeks)
or medical termination.
   

/
 

- Mifipristone (486) and Misoprostol given 2
days later.

- Ideally before 9 weeks, but can be used up to

24 weeks. If done before 9 weeks, 95% do not
need a &
because the process is complete,
but the timing or extent of bleeding is not able to
be anticipated.

IOOI
KT T T I M K SI  SM

TH
 TIS.
 _ 
0

‡ amage to
ervix 1 : 100

‡ xcessive leeding 1 : 1,000
‡ terine perforation 1 : 250
‡ lood group incompatibility-
incompatibility- rare, but give
anti-- if rhesus negative.
anti
‡ etained products of conception 1:100
 ' m * 
%

‡ Infection 1 : 10 (screen for STI first)

‡ egret
ommon.
‡ epression 1 : 40
‡ Problems in the future-
future- infertility,
premature labour, cervical incompetence.
 V KK PI I .
verybody agrees that,
there should be less abortions

‡ elay sex commencement *

‡ ncourage abstinence *
‡ elationship education *
‡ ppropriate contraception
* These apply particularly to young people.
 "

 !

‡ verage family size is 8 ± 12 children. child is

born every 2 years. Timing related to O.
‡ Oor centuries, disease limited family size.
‡ xponential world population growth in last 60
years.
‡
urrent world population = 6.7 billion.
‡ xpected world population 2030 = 9.0 billion
O
TS T MIS
I 

‡ It is very common, occurring in 15 ± 20%

of all recognised pregnancies.
‡ 1,000 per year in the island of Penang.
‡ Most occur between 6 and 10 weeks of
gestation.
‡ 60% due to chromosome abnormalities of
the fetus, most occurring at fertilisation.
 TI /MIS
I 
 efinitions: 6 types of miscarriage.
Threatened- PV bleeding but cervix closed, uterus =
Threatened-
. eeds /S to prove fetus is still alive.
Inevitable-- cervix open, but no P
passed. t = .
Inevitable
Incomplete-- cervix open, some P
passed. t < .
Incomplete
isk of further bleeding, infection, cervical shock.

omplete-- cervix was open, but could now be closed.

omplete
t < . P
passed completely.
Missed-- fetus is dead but in uterine cavity. t < .
Missed
May have had no PV bleeding.
Septic-- any of above which are infected (usually
Septic
incomplete ).
 
TPI
P


--1.
 Pregnancy at an ectopic site-
site- cervix, Oallopian
tube (most common), ovary, abdominal.
 Symptoms-- amenorrhoea, PV bleeding, pain
Symptoms
(75% presence on average).

linical features-
features- shock (rare), lower abdominal
tenderness, cervical excitation, adnexal mass or
tenderness, uterus not enlarged.
 Tests results: ß-h
 level and trend, /S (rarely
identifies ectopic pregnancy itself but finds
empty uterus).
 Treatment: peration/ methotrexate/ T.
 isk of recurrence is high.
 
TPI
P


--2.
 iagnosis:

linical features.
Pregnancy test positive
Vaginal ultrasound examination ± empty uterus,
occasionally see live ectopic. May see P fluid if
blood in peritoneal cavity.
ß-h
 level and trend ± usually < normal pregnancy.
 Treatment:
peration- laparoscopy/ laparotomy ± perform
peration-
salpinotomy or partial salpingectomy.
Methotrexate-- single or multiple dose therapy.
Methotrexate
lood transfusion.
 isk of recurrence is high.