1. Abortion & Islamic Perspective
Dr. Farhat R Malik
Associate Professor
Community Health Sciences

2. Session Objectives
At the end of this lecture the students will be able to;
Define abortion.
Explain causes of miscarriages in relation to trimesters.
Classify types of abortions.
Enlist complications of abortion.
Relate post abortion management in different types.
Know Islamic justifications and evidences from Holy Quran and Sunnah.

3. Miscarriage ( Abortion )
Definition
It is expulsion or extraction of products of conception before fetal viability i.e. before 24 weeks of gestation.
Incidence :
Is the commonest gynecological & obstetric disorder
About 15% of clinically recognized pregnancies end in abortion (this rise to 30% if unrecognized pregnancies are included).
Most abortions occur between 8 and 12 weeks of pregnancy.

4. Etiology First trimester abortion :
 Fetal chromosomal abnormalities - particularly trisomy , triploidy & monosomy
is the commonest cause of abortion
50– 70 % of the first trimester abortions are due to chromosomal abnormalities
the incidence of these abnormalities increased with the increase in the maternal age
An-embryonic pregnancy - Blighted ovum
Multiple pregnancy 4

5. Etiology First trimester abortion : Parental balanced translocation
Infections: genital tract infection , systemic infection with pyrexia & ToRCH syndrome
Endocrine disorders : Diabetes, thyroid disorders , PCOS & corpus luteum insufficiency
Uterine disorders: Uterine anomalies , sub- mucus fibroid & Asherman’s syndrome

6. Etiology First trimester abortion :
Thrombophilia: Congenital deficiency of protein C & S, & anti-thrombin III
Immunological disorders : An-ticardiolipin syndrome and SLE
Cigarette smoking , anaesthetic agents & chemical agents .
Psychological disorders 6

7. Etiology Second trimester abortion : Multiple pregnancy
Cervical incompetence (congenital & acquired )
Uterine anomalies and sub-mucous fibroid
Genital tract infection and PROM 7

8. Types Threatened abortion Inevitable abortion Incomplete abortion
 Missed abortion
Septic abortion
 Recurrent abortion

9. Complications of abortion
Hemorrhage (post Abortion Triad i.e pain, bleeding & Fever)
Complication related to surgical evacuation i.e E&C and D&C.
Uterine perforation- which may lead to rupture uterus in the subsequent pregnancy.
Cervical tear & excessive cervical dilatation – which may lead to cervical incompetence.
Infection – which may lead to infertility & Asherman's syndrome.
Excessive curettage – which may lead to Adenomyosis
 Rh- iso immunisation  if the anti –D is not given or if the dose is inadequate .
Psychological trauma , DIC, Infection, Shock etc
Related to anaesthesia
"Asherman's Syndrome" is a condition characterized by adhesions and/or fibrosis of the endometrium particularly but can also affect the myometrium. It is often associated with dilation and curettage of the intrauterine cavity. A number of other terms have been used to describe the condition. Asherman's syndrome is scarring (adhesions) of the uterus. This scarring causes lighter periods or no periods at all and, in almost all women who are affected, infertility.

10. Post - abortion management
In cases of incomplete, inevitable, complete, missed & septic abortions.
Support: from the husband, family& obstetric staff.
Anti D – to all Rh –ve, no-nimmunised patients, whose husbands are Rh+ve
Counseling & explanation:
Contraception (Hormonal, IUCD, Barrier) Should start immediately after abortion if the patient choose to wait , because ovulation can occur 14 days after abortion and so pregnancy can occur before the expected next period .

11. Post - abortion management
Counseling & explanation:
When can try again :
Best to wait for 3 months before trying again . This time allow to regulate cycles and to know the LMP, to give folic acid, and to allow the patient to be in the best shape (physically and emotionally) for the next pregnancy.
Why has it happened
Majority of cases there is no obvious cause
In the first trimester abortion , the most common cause is fetal chromosomal abnormality

12. Post - abortion management
Counseling & explanation:
Can it happen again
As the commonest cause is the fetal chromosomal abnormality which is not a recurrent cause , so the chance of successful pregnancy next time in the absence of obvious cause is very high even after 2 or 3 abortions
Not to feel guilty  as it is extremely unlikely that anything the patient did can cause abortion
No evidence that intercourse in early pregnancy is harmful
No evidence that bed rest will prevent it .. 12

13. ISLAM and ABORTION
“Slay not your children….the killing of them is a great sin.”
From the Qu’ran - Isra, Ayat 31
"And do not kill your children out of poverty; We will provide for you and them." [Anam: 151] "And do not kill the soul which Allah has forbidden, except by right." [Isra: 33].

14. ISLAM and Abortion
Today, Abortion in the Islamic world is ONLY allowed where the mothers life is in danger.
The main reason for this (similar to some Christians) is that most Muslims would argue that the mothers life is worth more than that of her unborn child.

15. ISLAM and ABORTION
It should be stressed that abortion is only performed as the lesser of two evils. The mother has established duties, responsibilities and relationships; a potential baby has not.
In Islam, as with other faiths, some women argue that it is a woman’s right to choose what she does with her own body.

16. ISLAM and ABORTION
Other points of view Muslims might offer is that the mother should NOT conveniently forget that her body affects others i.e. the unborn child
The Qu’ran says that on Judgement Day, the infants will want to know why they were killed.

17. ISLAM and ABORTION
We can see the importance of the mother overriding others in a passage from the Hadith:-
“A man came to the Prophet and asked ‘who among all people is most worthy of my good company?’. The Prophet replied ‘your mother’. The man asked ‘who next?’. The Prophet said ‘your mother’. The man then asked a third time and got the same reply. Only on the fourth time did the Prophet say ‘your father’ “

18. The Islamic Fiqh Assembly of the Muslim World League (Mecca)
"If the fetus has reached 120, it is impermissible to conduct an abortion even if it is medically diagnosed with congenital defects. However, if a committee of specialized physicians decided that the continuation of pregnancy imposes risk to the mother's life. In this case, it is permissible to conduct an abortion whether or not the fetus was deformed to undertake the lesser of two harms".

19. Sample Questions
“Do not kill your children out of poverty” are the words mentioned in our Holy Quran. Which of the following surah it is refering to?
Fatir
Isra
Anam
Baqqarah
Al Imran
A lady landed into OPD with ir regular bleeding and pain in abdomen. On inquiry she expressed that something expelled while urinating.
What could it be?
Enlist complications associated with it.