In Nepal, studies estimate that 15-30% of maternal mortality
can be attributed to the complications of incomplete, spontaneous or septic abortion. As
the major maternal referral center in Nepal, the Paropakar Shree Panch Indra Rajya Laxmi
Devi Maternity Hospital treats about 1,400 women annually who are suffering from
complications of incomplete abortion. Until recently, all of these cases have been treated
by dilatation and curettage (D&C) in the operating theater (OT) under general
anesthesia. This involves admitting patients to the hospital, and from 1 to 7 days spent
waiting for treatment and recovery. In addition, until now there has been no linkage
between treatment and much-needed family planning (FP) counseling and services.
Following nearly a year of planning, a model postabortion care (PAC) service and training
program was established at the Maternity Hospital in June 1995. This new unit, which is
located next to the admitting area, is designed to manage these cases in an ambulatory
setting using manual vacuum aspiration (MVA). During the first 6 months of operation (June
to December 1995) the PAC unit has saved the hospital and patients over 400 bed days and
282 operations under general anesthesia in the OT. The average length of stay has been
reduced from 36 to 3 hours, and no serious complications or deaths have occurred.
Discussion of the woman's reproductive goals and FP counseling are provided before or
after treatment, depending on her medical condition. In addition, the previously
nonexistent link to other reproductive health services has been established.
Despite the fact that almost one quarter of the patients are primigravidas who want
children, acceptance of FP has been high (70%) and generally has involved counseling of
both husband and wife. Excluding condoms (a small supply of which are provided to all
patients who do not leave with another FP method), the contraceptive methods provided
include: Depo Provera (37%), oral contraceptive pills (27%), and IUDs (5%). In addition,
about 3% of patients/couples were referred for Norplant® implants or voluntary
sterilization.
The Nepal program is one of a few PAC programs worldwide and is a model for the management
of incomplete abortions using MVA. Based on the initial experience with the Nepal program
it is concluded that MVA is a safe, effective procedure that can increase access to FP and
other reproductive health services.
Source: JHPIEGO Technical Report FCA-25. June 1996.
