If continuation of pregnancy carry risk to patient life or if the pregnancy continue there substantial risk that the child born with severe abnormalities as to be seriously handicapped

Objective To know the indication for termination of pregnancy To know the methods of terminations The complication s of termination

Pre abortion management Pre abortion assessment should include pregnancy test the gestational age is determind by menstrual history and by manual pelvic examination.Ultrasound scanning.A complete medical history should be taken particularly attention should be given to condition such as cardiac or respiratory disease,which may influence the choice of method of abortion.Blood should be taken for measurement of haemoglobin,blood group and Rh,screening for HIV,and hepatitis B

Methods of abortion The most methods of pregnancy termination were determined by gestational ages : Up to 9 weeks appropriate methods by medical abortion. From 7 to12 weeks by vaccum aspiration. From 12 to 15 weeks by either vaccum aspiration or by medical abortion. Greater than 15 weeks by medical termination. Vaccuum aspiration is dilating the cervix and passing acatheter into a cavity of the uterus,the uterine contents are usually aspirated by mechanical pump.

Medical abortion A number of drugs alone or in combination, can be used to induced abortion at various gestations. A synthetic derivative of naturally occurring prostaglandin E 1,it causes strong uterine contractions and softening and dilatation of the cervix. It is widely used in early medical abortion,mid trimester medical abortion and for preparation of the cervix prior to surgical evacuation of the uterus.E.g gemeprost, mesoprostol.these drugs are giving vaginally.

Mefipristone is a synthetic steroid that block biological action of progesteron by binding to its receptor in the uterus,following with drawal of the effect of progesterone, the uterus contracts and bleeding from placental bed, followed by abortion 2-5 days lator. However the rate of complete abortion is increased to 95%by adminstration of prostaglandin hours after adminstration of mifepristone.The dose of mefiprstone is 600mg orally followed by 36 to 48 hours by 1 mg gemeprost or 800 micro grams mesoprostol vaginally.Prostaglandin can cause bronchospsm so should not be used in asthma

Surgical evacuation : Is by dilatation and curettage this is done usually under general anaesthesia under aseptic technique to evcuate the uterus. Complications : 1- Persistance of placental or fetal tissue,this is the commonest complication following abortion. 2-bleeding oxytocine and ergometrine are helpful in reducing bleeding.

3-uterine perforation.This incidence is reduced if the evacuation done by experienced person. 4-genital tract infection,the use of prophylactic antibiotics to reduce the risk. Anti D should be adminsterd if the patient is Rh negative