A maternal death from self-induced medical abortion: a call for action

Abstract

Objectives: In Georgia, which has a longstanding, liberalised abortion law, the abortion procedure is generally safe if it is performed in a medical facility. However, when socioeconomic barriers prevent women from seeking safe abortion services, some risk their life by self-terminating an unintended pregnancy. We present a case of maternal mortality after a self-induced medical abortion, with the aim to investigate the underlying non-clinical causes of maternal death and the relevant policy implications.

Case: A 34-year-old socially vulnerable woman self-administered 10 tablets of oral misoprostol to terminate an 18-week pregnancy. She expelled the fetus the following day. A week later, she developed excessive vaginal bleeding, difficulty in breathing and tachycardia. She was hospitalised and diagnosed with sepsis due to a retained placenta. Uterine curettage and aggressive conservative management, followed by total abdominal hysterectomy, failed to stop the fulminant septic process. The patient’s condition deteriorated rapidly and she died 15 h after admission to hospital.

Conclusion: Socially disadvantaged women in Georgia have limited access to safe abortion services, and some are impelled to self-induce abortion in order to terminate an unintended pregnancy. Inclusion of family planning and abortion services in the Universal Health Care benefits package for socially vulnerable families may reduce the morbidity and mortality associated with unsafe abortion practices.

Chinese abstract

目的：在格鲁尼亚, 有一项长期存在的自由流产的法律, 如果在医疗机构中执行, 流产过程通常是安全的。然而, 当社会经济障碍阻止妇女寻求安全的流产服务时, 一些人会冒着生命危险来自行终止意外怀孕。我们介绍一例自行药物流产后孕产妇死亡的个案, 目的是调查潜在的非临床原因导致的孕产妇死亡以及相关的政策影响。

个案：一名34岁社会弱势女性自行服用10片口服米索前列醇以终止孕18周妊娠。第二天排出胎儿。一周后, 她出现大量阴道流血, 呼吸困难和心动过速。她入院治疗, 诊断为因胎盘残留导致的败血症。刮宫术和积极的保守治疗, 然后是经腹全子宫切除术, 都未能阻止暴发性败血症过程。病人病情迅速恶化, 入院后15小时死亡。

结论：在格鲁尼亚, 社会弱势妇女获得安全流产服务的机会有限, 一些妇女为了终止意外怀孕而被迫自行流产。将计划生育和流产服务纳入为社会弱势家庭提供的全民医疗保险福利套餐可能会降低与不安全流产相关的发病率和死亡率。

Keywords:

• Georgia
• maternal death
• medical abortion
• self-induced abortion

Disclosure statement

The authors report no conflicts of interest associated with this paper.