Gynaecologists said many young women — both married and unmarried — visit them with complications arising from the use of over-the-counter abortion pills.
Representational pic of a woman taking an abortion pill. Over-the-counter abortion pills can lead to death and several other complications warn doctors. (Wikimedia)
Medical experts have repeatedly warned against over-the-counter (OTC) drug abuse but still, people opt for self-medication, often with fatal consequences.
In one such instance, an 11-month-old baby was rendered motherless in Begur, Bengaluru, after the infant’s mother took an OTC pill to terminate her pregnancy. She bled to her death even before receiving medical care.
The Begur police have now registered a case of unnatural death following the demise of Priti Kushwala, a 33-year-old employee of an e-commerce firm.
Her husband Devbrath, a techie, told the police that Priti took the pill on her own accord, discarding his and her brother’s advice to consult a gynaecologist.
The young mother suffered excessive bleeding and lost consciousness on Tuesday, 13 December. Though she was rushed to a hospital, the doctors there declared her “dead on arrival”.
Priti is not an isolated case though several others did not face the same fate as of the e-commerce employee.
The number of women opting for OTC abortion pills could be perplexing if one goes by the figures Dr Soumya Sangamesh, Consultant Obstetrician and Gynaecologist of BGS Gleneagles Hospital in Bengaluru, provided to South First.
“Every week, I attend to at least four such cases that have developed complications after taking pills from a pharmacy without any medical prescription,” the doctor said. The cases add up to 16 on average each month, and 208 a year in one hospital alone!
“Termination of pregnancy should be done only under the care or instruction of a medical professional,” Dr Sangamesh warned.
Meanwhile, the Begur police are waiting for Priti’s post-mortem report to identify the pill and if the woman had died of an overdose.
Gynaecologists South First spoke to flagged back-to-back pregnancies as one of the reasons for individuals opting for OTC pills. They recommended at least a two-year gap between pregnancies.
Dr Sangamesh put the onus on healthcare providers to counsel women on the interval between pregnancies.
“It is the responsibility of healthcare providers to counsel the woman during her ninth-month pregnancy check-up on the importance of maintaining a gap of at least two years before the next pregnancy,” she said.
Women undergo tremendous physiological transitions during pregnancy and they need time to take care of themselves and their babies. People have a misconception that lactating women or those who have not got their first period after delivery, would not conceive.
“These are all myths. A woman can get pregnant even before her first menstrual period after delivery. She has to use contraceptives to avoid pregnancy,” Dr Sangamesh explained.
Citing Priti’s case, doctors said urban women, too, need counselling on family planning during their postpartum period.
Two main types of abortions are medical and surgical. Gynaecologists said abortions — Medical Termination of Pregnancy (MTP) — should be done only under the recommendations and supervision of a medical expert.
“In medical (method), a pill is prescribed for the termination of pregnancy. Whereas in the surgical method, the placenta is surgically removed. Even in the first case, a doctor should be consulted,” Dr Sangamesh explained.
The gynaecologist, however, added that neither of the two methods could be completely safe. “There are risks involved. A medical abortion could be recommended only when the woman is within her seven weeks of pregnancy or less than 63 days from her last period,” the doctor said.
The consulting doctor, if an MBBS degree holder, should have worked in the department of obstetrics and gynaecology for six months and has the licence to prescribe follow-up medications for MTP.
Additionally, the patient must be well-advised about the complications that may arise and the availability of medical help. The complications could be excessive bleeding, drop in blood pressure, discharge of heavy clots, or extreme fatigue.
“There has to be a follow-up visit after 15 days to scan for any Retained Products of Conception (RPOC),” Dr Sangamesh said.
RPOC refers to foetal or placental tissue remaining in the uterus after pregnancy. It could lead to bleeding, infection and other problems.
Surgical abortions are performed on women who are pregnant for more than seven weeks. It is performed after administering general anaesthesia.
“It is less complicated since the entire procedure is done in the hospital. The patient will be kept in the hospital for 24 hours or even discharged on the same day itself, depending on the duration of the pregnancy. If the placenta is more than 15 weeks old or more, the patient will have to stay back for a day,” Dr Sangamesh added.
Gynaecologists are worried. They said many girls and young women were brought to the hospital with heavy bleeding, dipping blood pressure and haemoglobin level as low as 2 g/dL. (Normal haemoglobin level for a woman is 12 grams/decilitre or higher).
Dr Pushpalatha R, a Bengaluru-based Obstetrician and Gynecologist spoke of several instances of unmarried women taking OTC pills and developing complications.
“They don’t inform their parents about their pregnancies and they mostly come with their friends or boyfriends. They should go for the termination of pregnancies through proper channels,” the doctor said.
Dr Pushapalatha said women often blindly trust their friend or friends, who had successfully terminated successfully using a particular pill.
“They go for the same pill. But each case is different, which they fail to understand,” she added.
Dr Sangamesh chipped in saying women often lie to their doctors as well. “This can be tricky. Many women tell me that it’s their second day of bleeding and they don’t know why it’s bleeding too much,” she said, adding that they would keep mum about the pill they had popped.
“Some even need three to four rounds of blood transfusion to compensate for the high blood loss. They come with severely low blood pressure. A scan will show that they were pregnant and then they will reveal about the pills,” she said.
Dr Kavya Priya Vazrala, Laparoscopic Surgeon and Infertility Specialist at Yashoda Hospitals in Hyderabad said the trend is the same in her city as well.
“We receive patients who take OTC abortion pills. Their situation would be very bad — with infections, low blood pressure and massive bleeding,” she said.
Doctors opined that several women have a misconception that it is expensive to consult a doctor and opt for buying a pill OTC or online for ₹300-400. A doctor’s consultation fee would be ₹500-800 while an ultrasound scan would cost ₹500-1,000, they said.
Consulting a doctor eliminates the risks and additional expenses required to treat possible complications. Moreover, it could save lives.
Dr Sangamesh says once a woman misses her period or confirms pregnancy using a home kit, she should visit a gynaecologist. After confirming the pregnancy through a blood and urine test, the doctor will recommend a compulsory ultrasound scan to re-confirm the pregnancy.
“Many women assume that the pregnancy will always be intrauterine. It is false. In some cases a fertilised egg grows in a fallopian tube. This is called an ectopic pregnancy or it could even be a twin pregnancy. Taking an abortion pill in such cases could be dangerous. An ultrasound scan can confirm tubal pregnancy,” Dr Sanghamesh added.
Dr Vazrala said popping abortion pills could burst an unruptured ectopic, causing heavy haemorrhage. “It could lead to death,” she warned.
The doctors recommend either a medical or surgical abortion depending on the gestation period. Even if the medical abortion is recommended the patient has to follow the doctor’s advice strictly and undergo follow-up checks.
The gynaecologists, in turn, should inform the patients about symptoms they should look out for and access to hospital care.
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