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most of the unsafe abortions are performed by untrained personnel leading to high mortality and morbidity
a 30 year - old female , gravida 7 , para 6 underwent uterine evacuation for heavy bleeding per vaginum following intake of abortifacient to abort a 14 weeks gestation .
the procedure was performed at a rural setup and her bowel was pulled out of the introitus through the perforated wound , an unusual complication of unsafe abortion .
illiteracy , unawareness about health services , and easy accessibility to untrained abortion providers lead to very high mortality and morbidity in india .
there is unmet need to bring awareness among the people about the safe and effective methods of contraception and abortion services to avoid such complications .
unsafe abortion is a significant medical and social problem worldwide . according to world health organization
, a woman dies every eighth minute in developing nation due to complications arising from unsafe abortion .
each year 42 million abortions are estimated to take place , 22 million safely and 20 million unsafely .
unsafe abortion accounts for 70,000 maternal deaths each year and causes a further 5 million women to suffer temporary or permanent disability .
approximately 1 in 10 pregnancies end in unsafe abortion , giving a ratio of 1 unsafe abortion to about 7 live births .
most of the unsafe abortions are performed in developing countries . in western nations , only 3% of abortions are unsafe , whereas in developing nations 5% are unsafe .
highest incidences of unsafe abortions take place in latin america , africa , and south east asia .
a survey of 2400 women in madhya pradesh , india , found that 32% of women aged 3539 years had attempted abortion at some time , and 23% had an abortion , indicating that roughly one in four women who attempted abortion did not succeed .
self induced morbidity was higher in rural areas ( 57% ) than in urban areas ( 45% ) .
severe complications were also more common in rural areas ( 35% versus 16% ) , showing that higher risks are associated with abortions in underserved rural areas . not unexpectedly
, only 9% of the women knew that abortion was legal , 49% thought that abortion was illegal , and 36% did not know its legal status ; the remaining 6% reported knowing that abortion was legal , but their knowledge of the period within which it was legal was incorrect .
the main causes of mortality or morbidity due to unsafe abortion are hemorrhage , sepsis , genital trauma , and bowel injury .
here we are presenting a case report of an unusual complication of unsafe abortion where bowel is pulled out of the vaginal introitus through uterine perforation [ figure 1 ] .
a 30 year - old female was admitted with complaints of pain abdomen and something coming out per vaginum since 2 hours following evacuation of the uterus done for an incomplete abortion following 3 months amenorrhoea .
she was a gravida 7 para 6 and had taken an abortifacient 15 days before the day of admission to abort an unintended 14 weeks gestation .
she had continuous bleeding per vaginum following that , for which she underwent uterine evacuation at a rural hospital .
, she was conscious but irritable and the pulse rate was 146/min , blood pressure 80/50 mm hg , and temperature was 100f . on abdominal examination , there was a vertical paramedian incision of previous caesarean section present .
per vaginum examination was not possible because of the bowel loops obstructing the introitus tightly .
her investigations revealed hemoglobin 7.5 gm / dl , white blood cell count 28,690/-ml , platelet count 3,91,000/ml , blood sugar 100 mg / dl , and serum creatinine 0.9 mg / dl .
a clinical diagnosis of uterine perforation with shock was made , and her exploratory laparotomy was performed after resuscitation .
peroperatively , the perforation was present in the fundal region [ figure 2 ] of the uterus , and about 3 feet of small intestine was pulled out through it , which was gangrenous [ figure 3 ] .
the gangrenous intestinal segment was resected close to the perforation and an end to end jejunoileal anastomosis was done .
the gangrenous intestinal segment was removed through the vagina and primary repair of the uterine perforation was done .
postoperatively she was kept on ventilator support for 2 days and three units of packed red blood cells , broad - spectrum antibiotics , and intravenous fluid were given .
the patient was multigravida and she wanted to terminate her unintended pregnancy for which she took some medicine herself .
she was brought to a rural setup nearby her village , where uterine evacuation was done which results not only perforation of the uterus but her intestine was also pulled through it out of the introitus leading to severe morbidity . in various studies , about 5577% of abortions were carried out by untrained and unqualified people.[57 ] these unqualified abortion providers are easily accessible to the clients in countries such as india .
illiteracy , unawareness about the available health facilities , hesitations and myths about contraception use , over the counter availability of the drugs for medical abortion , and easy accessibility to untrained abortion providers lead to very high mortality and morbidity in india .
complication due to unsafe abortion accounts for an estimated 13% of maternal deaths worldwide or 70,000 deaths per year . although bowel perforation is a well - known complication of unsafe abortion , pulling of bowel upto the introitus is an unusual complication of unsafe abortion .
in spite of legalization of abortion in india in 1971 , most of the abortions are done by untrained personnel .
factors inhibiting use of safe abortion where it is legal are lack of privacy and confidentiality , poor access , and discouraging attitudes of healthcare providers .
therefore , only legalization of abortion is not sufficient to reduce the number of unsafe abortions .
there is unmet need to bring awareness among the people about the safe and effective methods of contraception and abortion services so that such types of complication can be prevented .
unsafe abortion is a significant medical and social problem worldwide . in developing countries , 
 most of the unsafe abortions are performed by untrained personnel leading to high mortality and morbiditycase report : a 30 year - old female , gravida 7 , para 6 underwent uterine evacuation for heavy bleeding per vaginum following intake of abortifacient to abort a 14 weeks gestation . 
 the procedure was performed at a rural setup and her bowel was pulled out of the introitus through the perforated wound , an unusual complication of unsafe abortion . 
 illiteracy , unawareness about health services , and easy accessibility to untrained abortion providers lead to very high mortality and morbidity in india . 
 there is unmet need to bring awareness among the people about the safe and effective methods of contraception and abortion services to avoid such complications .