Objective: Assessment of abortion frequency in women of Karachi’s low socio-economic statusMaterial and Methods: A cross-sectional research was carried out on a group of 300 females. The participants of the sample group were the females from low socio-economic class of Lahore’s different hospital such as Mayo Hospital, Services Hospital, General Hospital, Surgimed Hospital, Fatima Memorial Hospital, and Ganga Ram Hospital for six months period commencing from March 2018 to August 2018. A self-administered survey form/questionnaire was circulated and after the informed oral consent from the females it was filled out. An experimental study was done for the assessment of the questionnaire’s validity. SPSS version 20 was used for the data analysis with confidence interval 95%, 5% as margin of error and value of p 0.05 was regarded significant.Results: An interview was conducted of 300 females through the questionnaire. The females’ median age was 25-40 years. Monthly income of 65.1% family was below Rs 10,000/- and the income of 82 females was 11,000 to 17,000. 173 females (57.66 %) with vaginal bleeding signifying  the risk of abortion visited the doctor  (p value 0.037), Ultra Sound revealed the abnormality of aborted baby of 174 females (58 %, p value 0.040), during the first trimester of pregnancy 121 females (40.33%) had infections (p value 0.029),during the first trimester of pregnancy, 92 females (30.6%) had used antibiotic capsule for infection (p value 0.040), 71 females (23.6%) had trauma (p value 0.003), 172 females (57.33%) were having cervical incompetence (p value 0.021) and during the pregnancy the females who had lifted the heavy stuff were 61.2% (p value 0.059).Conclusion: The research has concluded that the rate of abortion risk in females of low socio-economic class is high and the awareness level is unsatisfactory regarding risk and causing elements of spontaneous abortion. In order to avoid undesired results of pregnancy, more efforts are required to assist both the young and adult females of low socio-economic class. Preventive measures are critically required to be taken in order to save the health of females and children of low socio-economic status.Key Words: Awareness, Cervical Incompetence, infection, Spontaneous Abortion, Traum

Khadim, Dr. Muhammad Imran

Nawaz Cheema, Dr. Bilal

Sarwar, Dr. Muhammad

Asian Journal of Multidisciplinary Studies (AJMS)

ISSN: 2321-8819 (Online) 2348-7186 (Print) Impact Factor: 1.498 Vol. 6, Issue 9, September, 2018  
53 
Asian Journal of Multidisciplinary Studies, 6(9) September, 2018 
 
  
  
 
 
 
Spontaneous Abortions in Women of Lahore belonging to low-socioeconomic status 
 
Muhammad Sarwar*1, Bilal Nawaz Cheema2, Muhammad Imran Khadim3 
*1Corresponding author: Medical Officer, Basic Health Unit 140/M, 00923067852956, 
drsarwar1339@gmail.com 
2 Medical Officer, Basic Health Unit, Ferozewala, Gujranwala, 00923217920420, cheema.5z89@gmail.com 
3 Medical Officer, Basic Health Unit Shikar Pur, RajanPur, 00923332502288, 
muhammadimrankhadim9394@gmail.com 
 
ABSTRACT  
Objective: Assessment of abortion frequency in women 
of Karachi’s low socio-economic status 
Material and Methods: A cross-sectional research was 
carried out on a group of 300 females. The participants 
of the sample group were the females from low socio-
economic class of Lahore’s different hospital such as 
Mayo Hospital, Services Hospital, General Hospital, 
Surgimed Hospital, Fatima Memorial Hospital, and 
Ganga Ram Hospital for six months period commencing 
from March 2018 to August 2018. A self-administered 
survey form/questionnaire was circulated and after the 
informed oral consent from the females it was filled out. 
An experimental study was done for the assessment of 
the questionnaire’s validity. SPSS version 20 was used 
for the data analysis with confidence interval 95%, 5% as 
margin of error and value of p 0.05 was regarded 
significant. 
Results: An interview was conducted of 300 females 
through the questionnaire. The females’ median age was 
25-40 years. Monthly income of 65.1% family was 
below Rs 10,000/- and the income of 82 females was 
11,000 to 17,000. 173 females (57.66 %) with vaginal 
bleeding signifying  the risk of abortion visited the 
doctor  (p value 0.037), Ultra Sound revealed the 
abnormality of aborted baby of 174 females (58 %, p 
value 0.040), during the first trimester of pregnancy 121 
females (40.33%) had infections (p value 0.029),during 
the first trimester of pregnancy, 92 females (30.6%) had 
used antibiotic capsule for infection (p value 0.040), 71 
females (23.6%) had trauma (p value 0.003), 172 females 
(57.33%) were having cervical incompetence (p value 
0.021) and during the pregnancy the females who had 
lifted the heavy stuff were 61.2% (p value 0.059).  
Conclusion: The research has concluded that the rate of 
abortion risk in females of low socio-economic class is 
high and the awareness level is unsatisfactory regarding 
risk and causing elements of spontaneous abortion. In 
order to avoid undesired results of pregnancy, more 
efforts are required to assist both the young and adult 
females of low socio-economic class. Preventive 
measures are critically required to be taken in order to 
save the health of females and children of low socio-
economic status.  
Key Words: Awareness, Cervical Incompetence, 
infection, Spontaneous Abortion, Trauma 
 
INTRODUCTION 
Removal of conception products before reaching 
gestation’s twenty-fourth week and when the 
weight of foetus is 0.5kg or less is referred as 
abortion. Spontaneous abortion is that when it 
naturally occurs due to some pregnancy’s physical 
problem and without medical intervention (Singh 
2006). There are two types of Spontaneous 
Abortion; 
1. Early Pregnancy Abortions 
2. Late Pregnancy Abortions Gestation 
therefore it is known as First Trimester 
Miscarriage.  
If an abortion occurs before the twelfth week is 
called Early Pregnancy Abortion whereas if it 
occurs between the twelfth and twenty-fourth week 
of gestation is called Late Pregnancy Abortion. 
Early Pregnancy Abortion is quite common than 
the Late Pregnancy Abortion. The chromosomal 
abnormalities are the most significant reason for 
early pregnancy loss (Karim, Memon & Qadri 
2010). There are other causes such as uterine 
abnormalities, endocrine disorders and 
immunological elements. Maternity at young age 
was consistently and considerably connected with 
high threats of death and anaemia. Unsafe abortion 
is causing 10% of maternal deaths according to a 
research conducted from Karachi (Barnett et al. 
2005). To find out the abortion rate in Pakistan, a 
study was carried out from January 2005 to 
December 2006 in Liaqat Medical College 
Hospital, Hyderabad. Mostly the occurrence of 
abortion cases in females was between the age of 
25 to 40 years (Virk, Hsu & Olsen 2012). The most 
frequent kind of abortion was incomplete and 
occurred mostly during the gestation’s 8-12 week 
(Saleem & Fikree 2001). The research endeavoured 
to locate in the low socio-economic class females 
the frequency and reasons of spontaneous abortions 
as the low income earning has high threats of 
abortion (Vienne, Creveuil & Dreyfus 2009). By 
this research the most frequent cause and risk 
element of abortion can be determined and what 
steps should be adopted to improvise the end result 
of abnormal pregnancy and introduction relating to 
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preventive measures awareness in low socio-
economic status in order to secure the pregnancy 
outcomes (Sathar 2014).  
Abortion: Spontaneous Abortion has been defined 
as, recognising the loss of pregnancy clinically 
before the gestation’s twentieth week (Ford & 
Schust 2009). According to World Health 
Organisation, abortion is an extraction or expulsion 
of foetus or embryo weighing 0.5kg or less. 
Pregnancy enjoys an important place in the life of a 
female and in the early 1st trimester the emotional 
attachment and development of baby starts (Shah et 
al. 2009). Most the females, it is very hard 
experience for them to have a loss in first trimester. 
When it happens, the sorrow is so deep like 
Spontaneous abortion (end of pregnancy before the 
reaching of foetus at gestational age) or peri-natal 
and is one of the most common complicated 
pregnancy (Fawad et al. 2008). Approx. identified 
pregnancy 12 – 15 % and the rest of pregnancies 17 
– 22 % culminates in Spontaneous Abortion. The 
miscarriage is similar to spontaneous abortion as in 
the absence of surgical or medical measure, its 
occurrence spontaneous. The loss of pregnancy 
spontaneously has been recommended in order to 
escape from the term abortion and to recognise the 
emotional elements relating to pregnancy loss 
(Rasch 2011).  
Risk Factors: There are some threatening elements 
which can possibly enhance spontaneous abortion 
chances. The risk factors include: lifting heavy 
weights, use of antibiotics, radiation exposure, 
recurrent infections, no visiting to health 
professional, NSAIDS enhances the abortion risk in 
early pregnancy and miscarriage in on high risk in 
obese pregnant females, earlier miscarriage 
enhances the subsequent abortion risk, the use of 
anti-depressant by the pregnant females enhances 
68% chances of miscarriage (Mehrunnisa 2002).  
Rationale: The rationale is to determine the 
abortion rate in Karachi’s low socio-economic 
females with object to enhance the knowledge 
relating to spontaneous abortion, to enhance 
preventive measures in order to secure the 
pregnancy result with recurrent abortions resulting 
in loss of blood in females and the haemoglobin 
level goes down and become an easy target for 
infection (Brier 2008). The assessment must be 
performed by uterine and ovarian, karyotyping, 
lupus anticoagulant, anticardiolipin antibodies, 
screening for diabetes, thyroid function test and 
endometrial biopsy. The general public must be 
educated regarding abortion’s complication of life 
threatening such as perforations and tear, 
haemorrhage, uterine infection, cardia arrest, blood 
clots in uterus and death (Zhang et al. 2010).  
MATERIALS AND METHOD 
A cross sectional research was carried out on a 
group of 300 females. The few participants of the 
sample were from Tertiary Care Hospitals, from 
Government and Semi Government Hospitals such 
as Mayo Hospital, Services Hospital, General 
Hospital, Surgimed Hospital, Fatima Memorial 
Hospital, and Ganga Ram Hospital for six months 
period commencing from March 2018 to August 
2018. An informed oral consent from the females 
was taken. An experimental study was done for the 
assessment of the questionnaire’s validity. 
A self-administered survey form/questionnaire was 
circulated and the same was completed by the 
females. SPSS version 20 was used for the data 
analysis with confidence interval 95%, 5% as 
margin of error and value of p < 0.05 was regarded 
significant. 
Selection Criteria 
Inclusion Criteria: Spontaneous abortion in 
females ranging from 25-40 years of age with 1st 
live birth from low socio-economic status having 
monthly income from Rs:10,000/- to Rs:17,000/-.  
Exclusion criteria: Females having no live child, 
coming from high socio-economic status, induced 
abortion and infertile.  
Data Entry and Analysis: Statistical Package for 
Social Sciences version 20 was used for analysing 
the collected data. Percentages and frequencies 
were counted with numerical variable such as age. 
Chi-square applied for forming connection in 
between variables, margin of error as 5% and level 
of confidence as 95% and the value of P <0.05 as 
significant. In research the statistical tool is cross 
tabulation.  
RESULTS 
An interview was conducted of 300 females 
through the questionnaire. The females’ median 
age was 25-40 years.  
Family monthly income of 65.1% of female was 
below Rs: 10,000/- and the family income of 82 
females was 11,000 to 17,000. 37.4%Females were 
having number of children 2-3(p=0.000). 85.2% 
females were the housewife. 62.3% females had 
undergone the abortion between the gestation 
period 11-20 (p=0.045). 94.23% females had 
undergone abortion 2-3 time. 173 females (57.66 
%) with vaginal bleeding signifying  the risk of 
abortion visited the doctor  (p value 0.037), Ultra 
Sound revealed the abnormality of aborted baby of 
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174 females (58 %, p value 0.040), during the first 
trimester of pregnancy 121 females (40.33%) had 
infections (p value 0.029),during the first trimester 
of pregnancy, 92 females (30.6%) had used 
antibiotic capsule for infection (p value 0.040), 71 
females (23.6%) had trauma (p value 0.003), 172 
females (57.33%) were having cervical 
incompetence (p value 0.021) and during the 
pregnancy the females who had lifted the heavy 
stuff were 61.2% (p value 0.059). 172 females were 
aware of the causes of abortion (p=0.035). 62.4% 
females were seeking medical advice (p=0.062) 
and 31.4% females were asked not to left weight 
for four to six months (p=0.012). 25.3% females 
were asked to use folic acid before going for next 
pregnancy (p=0.050).  
DISCUSSION 
The following suggestions have been made in the 
research by council of Pakistan population; 
1. According to the research regarding 
finding the abortion rate in Pakistan was 
carried out by Liaqat Medical College 
Hospital, Hyderabad during January 2005 
to December 2006 and found that the 
annual rate of abortion is about 29 in 
Pakistan. The estimation was made on the 
2014 patients of gynaecology, out of that 
the abortion cases were 240 and the 
abortion prevalence was 11.4%. Majority 
of abortion cases were carried out between 
the age of 26-35 years. The abortion 
prevalence grows as the parity enhance 
per 1000 females age between 15-49 
years. If this continues then every 
Pakistani female will undergo abortion in 
her life.  
2. Abortion terminates the pregnancies 1 out 
of 7. 
3. The rates of connected morbidity and 
mortality are high. 
4. 23% Pakistani females who are 
hospitalised for treating the complication 
they undergo abortion.  
As compared to India, the rate of abortion is high in 
Pakistan. The object of this current research was to 
assess the effect of low socio-economic class on 
the result of the pregnancy, for that very object 300 
females were interviewed who stereotypically 
showed the social pattern in threats of spontaneous 
abortion. The selected indicators of socio-economic 
class were primarily occupation of parents, status 
of nutrition, lifestyle factors, income of the family 
and proper presence at setups of antenatal which 
are affecting the outcome of the pregnancy either 
quantitatively or qualitatively. Dickson conducted a 
study in 2005 and suggested spontaneous 
abortion’s two-fold threat in low socio-economic 
class as compared to high socio-economic class. 
Another research supported our outcomes which 
assess that 86% out of all abortions conducted are 
spontaneous abortion because of intrauterine 
growth retardation, malnutrition and occurrence at 
high rate in teenage mothers. The rate of annual 
hospitalisation is varying from low of 3 per 1000 
females in Bangladesh to high of 15 per 1000 
females in Uganda and Egypt. The rate in Pakistan, 
Nigeria and Philippines is 4-7 per 1000 and the rate 
of two Latin American countries are 9 per 1000. 
Significant contribution has been made by the 
induced sceptic abortion to maternal mortality and 
morbidity. The incidence can be reduced by the 
effective family planning and improving the rate of 
literacy in population of the women. Different 
resources in the community should be utilised for 
the development of awareness of risk of induced 
abortion. Countries with abortion restriction, there 
females need to find some clandestine interference 
to terminate the unwanted pregnancy. 
Consequently, the unsafe abortion can be seen at 
high rate for example the rate of unsafe abortion in 
Sub-Saharan Africa is 18-39 per 1000 females. The 
focus of the research was on females from low 
socio-economic background having income > Rs: 
10,000/- Rs:20,000/-. As the occupation was 
considered as risk but majority of the interviewed 
females were housewife. Mostly 42.4% females 
were between the age of 26-35 years, because age 
is threatening element for abortion and many 
females had undergone the 1st abortion between the 
age of 21-25 years. The study conducted in China 
had the similar findings. Females of this age had 
only 2-3 children whereas the total number of 
abortions with range 1-4 suggesting a huge number 
of abortions is the death for a female. Half of the 
females undergoing abortion had knowledge about 
its causes and the rest did not inquire from their 
doctor or had no knowledge about the causes. As to 
the trend in Pakistan, 61% abortions are performed 
with consultation of ayas and dais at home. 
Normally in the first trimester almost half of the 
abortions i.e., 57.1% were carried out. The research 
had revealed the most common purpose for visiting 
the dais or doctor i.e., bleeding from vagina which 
suggested abortion. According to our study, the 
possible reasons for undergoing the abortions were 
showing of abnormality of aborted baby in Ultra 
Sound during the 1st trimester, taking of any 
capsule/antibiotic by females for any infection 
during the first trimester of pregnancy, any trauma 
occurring during the period of her antenatal, 
females suffering from cervical incompetence, 
females who had lifted heavy thing such as heavy 
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bucket. Mostly females consult doctor for having 
advice relating to next conception and the result of 
future pregnancy, after abortion doctors advised not 
to have pregnancy for next 4-6 months.  For the 
prevention of defects in child females are advised 
before the next conception to use folic acid. The 
focus of the post abortion care is on the incomplete 
abortion treatment and providing service of post 
abortion contraceptive. To increase the access of 
females to post abortion care, the main focus was 
on the upgrading of providers of midlevel for the 
provision of emergency treatment and the 
implementation of misoprostol as a strategy for 
treating the post unsafe abortion complication. The 
causes can be prevented by the provision of 
effective services of family planning and by 
improvising the social and educational level of 
females with the provision of awareness relating to 
antenatal care therefore reduces the abortion 
incidence.  
 
 
CONCLUSION 
The conclusion of the study is that the abortion 
frequency occurring in low socio-economic class is 
high and the awareness level regarding prevention 
measures and the threatening elements of 
spontaneous abortion are not satisfactory. Further, 
abortion rate increase results in the more mortality 
and morbidity. Policy and research which 
acknowledges the significance of all the features of 
reproductive health of females such as awareness 
relating to prenatal, natal and postnatal care, proper 
antenatal care, provision of good financial and 
social support to pregnant females are necessary in 
order to meet the reproductive health care 
requirements of low socio-economic females. In 
order to avoid unwanted results of pregnancy more 
efforts are required to provide help to adolescent 
and adult females belonging to all economic 
classes. There is dire requirement for taking 
measures of preventions in low socio-economic 
status in order to save female and children from 
mortality and morbidity and to make the society 
more flourish and sound. 
 
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Spontaneous Abortions in Women of Lahore belonging to low-socioeconomic status

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Spontaneous Abortions in Women of Lahore belonging to low-socioeconomic status

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