Monika Gupta

Abstract

Introduction: With the passage of MTP act and later its amendment, abortion was legalised in India. There are clear guidelines on who should prescribe the pills. But owing to over the counter availability of the abortion pills, its self-prescription is widely rampant. Aims: This study aims to analyse the effects of unsupervised self-prescription of abortion pill on the maternal health. Materials and Methods: This was an observational study done on 100 consecutive women of reproductive age group (15-45 years) seeking advice at Family planning OPD or Gynaecology emergency department of a tertiary teaching institute after self-prescription of abortion pill. The socio-demographic parameters along with source of pill procurement, gestational age at pill intake, time since pill intake, clinical presentation, medical management or surgical intervention and the final outcome was noted and analysed. Results: The 100 women sought medical advice over 4 months duration. Of them, 75% were multipara, 77% were urban dwellers and 83% belonged to low socio-economic status. Source of procurement was ultimately the pharmacists for all women.72% women took pill after 7 weeks of gestation and15% took it in second trimester. 55% presented to the health facility within 2 weeks of pill intake. Lack of use of regular contraception was the basic reason behind all women. Only 5 % took the abortion pill with proper regime.30% had incomplete abortion, 20% had incomplete abortion with shock,15% had incomplete abortion with sepsis,25% had failed abortion and 8% presented with shock and severe anemia with only 2% with complete abortion. Although 100% women had complete recovery, yet surgical intervention was needed in 76% women. Evacuation was done in 69%, additional misoprostol was given in 21%, 7% cases underwent laparotomy for rupture ectopic while one case needed only Blood Transfusion. Blood transfusion along with surgical intervention was needed in 17 % cases while broad spectrum antibiotics were needed in 15% cases of sepsis. One woman underwent hysterectomy following post-abortal sepsis with pyoperitoneum. Conclusion: The results are an eye-opener. The over the counter availability of the abortion pill must be checked and focus should be made on counselling the women regarding the use of regular contraception practices. Keywords: Over the counter, Self-prescription, MTP pill, Unsupervised medical abortion.

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Abstract

Objective: To evaluate seroprevalence of Rubella infection in antenatal patients with bad obstetric history (BOH), pregnancy outcome of seropositive cases and incidence of congenital malformations in maternal Rubella infection. Materials and Methods: This was a prospective case control study done at a tertiary teaching institute over duration of one year. One hundred and seventy four antenatal women with BOH were studied against one hundred and six control cases. Their serum sample was subjected to ELISA test for Rubella IgG and IgM antibodies estimation at their first antenatal visit. Interconception interval i.e. the time interval between the previous pregnancy loss and current pregnancy was noted. All women were followed to know the pregnancy outcome. Apparent congenital anomalies in the newborns were evaluated. Chi square test was applied for statistical analysis. Result: Seropositivity for Rubella IgG antibodies, IgM antibodies and both IgG and IgM was 48.3%, 25% and 3.5% respectively in study group. Abortions, preterm delivery and stillbirths were seen in 56.8%, 18.3% and 4.5% of IgM positive cases. 2.24% with IgG positive had abortion while 4.5% with both IgG and IgM antibodies had fetal congenital malformation. Incidence of congenital anomalies in the form of Neural Tube Defects was 4.48%. Abnormal pregnancy outcome in present pregnancy was seen in 59.1% of women with interconception interval less than 3 months. Conclusions: Seropositivity of IgM Rubella antibodies was significantly higher in women with Bad Obstetric History. Incidence of Neural Tube Defects was higher with Rubella infection if exposure occurs in first few weeks of pregnancy. There is need for immunization against Rubella, of adolescent girls and seronegative prospective mothers. A proper (more than 3 months) interconception interval should be recommended after acute Rubella infection in pregnancy causing obstetric loss in that pregnancy. Keywords: German measles, Rubella in pregnancy, Pregnancy loss, Interconception interval.

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