INTRODUCTION:

The promising dawn of 21^st century has already started, knocking at the doors of people all over the world. The new century fills people with new hopes to yet again reset targets for achieving the two decade old WHO slogan of "Health for all by 2000 AD". It is a fact that these goals have not been realized in many parts of the developing world. Despite large inputs in terms of manpower, infrastructure and other resources the health of mothers and children still remains a problematic challenge in many developing countries.

The Government of India introduced a new programme to achieve unattained goals and cater to the health needs of unreached and under-served people whose unmet needs largely contribute to the population and other problems with which the country is fighting. This new programme named "Reproductive and Child Health (RCH) Programme" was launched in 1997 incorporating some of the ideas that arose out of the discussions at the International Conference on Population and Development held in Cairo in 1994.

The RCH programme aims to broaden health care to include all reproductive health problems of the people and not limit services only to maternal and child health and family planning. The reproductive and child health programme specially aims at improving the health status of mother and child through a wide range of services. Hitherto neglected areas like adolescent health, abortion services and STDs are also given attention under the RCH programme.

Post abortion services are specially important because of the vulnerability to maternal morbidity and mortality. The private and sensitive nature of the problem shrouds it in taboos and mystery making it difficult for women to seek services after abortion.

In the best of circumstances, most women feel fulfilled and happy when they conceive. But pregnancy turns out to be hazardous and even life threatening for many women in developing countries. Abortion and its complications put the women at risk in the first few months of pregnancy.

According to hospital statistics available in SATH, Trivandrum 5 to 7% of all pregnancies ended up as spontaneous abortions in 1999. Spontaneous abortion and the factor influencing it has been the subject of discussion in many studies. Causes and risk factors of spontaneous abortion have been studied in detail. According to Bohrer and others obese women weighing over 81 kg or more and those aged 35 years and above are at increased risk to have a spontaneous miscarriage in the first trimester. In another study by Calle (1991), women aged over 35 years and those with previous history of spontaneous abortion were found to be at higher risk for spontaneous abortion.

Goulet and Thesiault (1987) focused attention on the association between spontaneous abortion and ergonomic factors and found that among the ergonomic factors heavy lifting and physical effort were associated with increased risk of spontaneous abortion. Lapple and Lukesch (1988) found that certain psychological factors such as anxiety and nervousness, psychosomatic and personality disorders, negative attitude towards sexuality and pregnancy, and parental conflicts have a negative impact on pregnancy outcome.

Previous abortion increases the woman's risk for abortions in subsequent pregnancies. In 1991, Van Iddeknge conducted a study on the etiological factors of recurrent spontaneous abortions and subsequent reproductive performance in 76 couples. The study revealed that endocervical infections, cervical incompetence and uterine abnormality accounted for increased risk of spontaneous abortion (18%, 11% and 9% respectively). Heister reported that previous induced abortion and history of pelvic inflammatory abortion disease had a direct correlation with spontaneous abortion whereas age of mother showed an inverse correlation. Ansary and Babay (1994) found that the number of previous abortions related linearly to the risk of aborting spontaneously in the next pregnancy.

Spontaneous abortion was also associated with daily consumption of more than 150 mg of caffeine, abdominal trauma, infection and fever during pregnancy. Ansary and Oni also pointed out a positive association of age at menarche and risk of spontaneous abortion. Also there was a significant higher risk of spontaneous abortion when a woman was manned to a blood related husband. The risk also increases with previous history of abdominal trauma and infection during pregnancy.

Bergant and Renstadler (1997) found that psychological factors seemed to be of subordinate importance as a cause for recurrent spontaneous abortion. Moreover physical abnormalities of the reproductive system have a predominant impact on the prediction of future pregnancy.

The threat of abortion and other forms of maternal morbidity are present for all women though some are more vulnerable. Pregnancy loss is a painful experience whether it is wanted or undesired. Maternal factors play a major role in spontaneous abortion. Mother's health status, age, working status, diseases present in the pre pregnant period and the conditions associated with pregnancy influence abortion. This study was conducted to analyze the maternal factors affecting spontaneous abortion.

MATERIAL AND METHODS:

An analytical study was conducted in the Department of Obstetrics and Gynaecology of SAT Hospital, Trivandrum in 1999. A case control study design was used to analyze the factors leading to spontaneous abortion with 60 cases of spontaneous abortion and 60 cases of pregnant women with other conditions.

The population of the study was the total number of spontaneous abortion cases registered in one year (during 1999) in SAT hospital and women with history of spontaneous abortion who were admitted in SAT Hospital for safe confinement during the study reference period. All women who were admitted after spontaneous abortion which included postnatal women as well as antenatal women (before the abortion) were considered as the representative group. A fixed sample size was decided and the cut-off limit was 60 women.

Causes associated with medical conditions like gestational diabetes mellitus, pregnancy induced hypertension, heart diseases were included in the control group.

A pretested precoded proforma was used for the collection of data. The data collected included the following: level of physical activity of the women during pregnancy, any history of long travel, history of trauma or fall, sexual activity during first trimester, history of previous abortion and family history of abortion and nature of marriage for consanguinity.

FINDINGS OF THE STUDY:

During the study period 60 cases each were registered into the study group as well as the control group. They were carefully analyzed for obtaining the required information. The two groups were compared for the presence of selected maternal factors. The case and control groups were also compared.

Age:

In this study, an increased chance of abortion was found among the pregnant women .aged below 30 years. Out of the 60 cases studied, 50 (83%) were in the less than 30 year age group.

Place of residence:

There was no considerable difference between the two groups in relation to the place of residence. There were very few women from urban areas.

Occupation, Education, Religion and Income:

There was no significant relationship between occupational status of women and risk of abortion. The control group was found to be identical with study group in occupational status. Added to this, no significant difference was found between the case and control groups with regard to education, religion and income.

History of trauma:

There was no significant relationship between spontaneous abortion and the history of trauma or previous abortion.

Physical activity:

Physical activities such as heavy household work like drawing water from well etc were found to be contributing factors for spontaneous abortion. In the study group 32% had such history whereas only 3% reported any such history in the control group.

Associated Illnesses:

The presence of an associated illness such as epilepsy, heart disease etc may also be contributing factors for spontaneous abortion because 23.33% of the pregnant women among the cases had such morbidity compared to none in the control group.

Gravida:

Majority of the women (92%) in the control group were having gravid status < 2 compared to 58% in the study group.

Rh typing:

Contrary to expectation the Rh typing -showed no association with risk of abortion. The case and control groups were similar in this respect.

Other findings:

In the present study attempts were made to assess association between hyper emesis reported in the current pregnancy, history of intake of antibiotics, etc with the occurrence of spontaneous abortion. The findings revealed that a higher percent of the women in the study group had hyper emesis (31%) compared to the control group (22%). This finding seems to indicate an association between the two. The history of intake of antibiotics was also reported to be similar in the two groups - about 7-10%.

Type of family:

The analysis showed that the incidence of abortion was more in women living in nuclear families compared to those in joint families. This high incidence of spontaneous abortions among women who live in nuclear families could be due to the inadequate antenatal care and lack of acknowledge and support.

History of consanguineous marriages:

In the present study 5% of the abortion group had a history of consanguineous marriage. The corresponding percentage in the control group was 11.66%. However the difference noted was not statistically significant.

History of previous abortion:

Out of 60 cases under study, 76.6% of women in the study group had history of previous abortion where as only 16.67% of women in the control group had similar history. This finding is strongly suggestive of the repeated nature of spontaneous abortion among some women.

Family history of abortion:

Risk of abortion was noted to be 17% among women with family history of abortion compared to women in control group (7%).

Period of gestation:

Out of 60 cases taken into the study group, 75% had spontaneous abortion within the first trimester, while the remaining 25% had spontaneous abortion beyond first trimester.

CONCLUSION:

The findings of the study reveal that certain maternal factors, such as previous abortion strongly influence spontaneous abortion in the present pregnancy. The study also reflected the gaps in information about safe abortion services among women who had sponteneous abortion. The findings of the study will help to design appropriate interventions to identify women with anemia and take preventive measures.

REFERENCES:

William Bates, Mechel, E. Riv (1990).Manual of clinical problems in obstetrics and gynecology, (3^rd Edition) Little Brown Company Pp 5-10.

Chaudhari, S.K. (1992). Practice of fertility control. (3^rd Edition) B.I. Churchill Livingstone Publishers, New Delhi Pp 222-227.

Fernando, Arias (1990) Management of Delivery. (1^st Edition), C.V. Mosby Company Pp 31-32,237.

Friedman, Borten, Chaplin (1990) Gynecological decision making, (2^nd Edn.) Jaypee Brothers Medical Publishers Pp 74, 75-78.

Michael de Swiet (1995). Medical Disorders in Obstetric Practice. (3^rd Edi) Blackwell Science Publishers Pp: 276,156, 162,493,520..

Received on 06.08.2014 Modified on 20.08.2014

Int. J. Adv. Nur. Management 2(3): July-Sept.,2014; Page 159-161