**6. Elements of post abortion care**

The original PAC model consisted of three elements drawn specifically from health care delivery providers perspective without taking due cognizance of the need to accommodate the psychological and physical feelings of the client as well as the community who are the beneficiaries of the services. The three elements of the original PAC model include the following:


However in 2001, the PAC Community Task Force expanded the model to five elements, tailored to provide the necessary ingredients for sustainable PAC services by making them more client-oriented. The five elements are:


Post Abortion Care Services in Nigeria 131

Adinma, JIB., Ikeako, L., Adinma, ED, Ezeama, C., & Eke, NO. (2010). Post abortion care

Ahiadeke, C. (2001).Incidence of induced abortion in southern Ghana. *International Family* 

Ahman, E., & Shah, I. (2002). Unsafe abortion: worldwide estimates for 2000. *Reprod. Health* 

Bankole, A., Oye-Adeniran, BA., Singh, S., Adewole, IF., Wulf, D., Sedgh, G., & Hussain, R.

Centre for Reproductive Rights regarding maternal mortality in Nigeria – universal periodic

Cooks, RJ., Dickens, BM., & Bliss, LE. (1999). International developments in abortion laws

Fatusi, AO., & Ijadunola, KT. (2003). National study on emergency obstetrics care facilities in

Faúndes, A., & Barzelatto, JS. (Eds). (2006). *Consequences of unsafe abortion — The human* 

Henshaw, SK. (1990). Induced abortion: a world review. *International Family Planning* 

Henshaw, SK., Singh, S., Oye-Adeniran, BA., Adewole, IF., Iwere, N., & Cuca, YP. (1998).

Henshaw, SK., Singh, S., & Haas, T. (1999). The incidence of abortion worldwide.

Post abortion Care Consortium Community Task Force. (2002). Essential elements of post

Programme of Action adopted at the International Conference on Population and

Rahman, A., Katzive, L., & Henshaw, SK. (1998). A global review of laws on induced abortion, 1985-1997. *International Family Planning Perspective*, 24, 56-64.

Rogo, KO. (1993). Induced abortion in sub-Saharan Africa. *East African Medical Journal*, 70, 6,

World Health Organization. (2001). Maternal Mortality in 1995: Estimates developed by WHO, UNICEF and UNFPA. WHO/MSM/01.9 Geneva: WHO, 2001. World Health Organization.(1998). Unsafe Abortion. Global and Regional estimates of

incidence and mortality due to unsafe abortion with a listing of available Country

*http://annualreview.law.harvard.edu/population/abortion/NIGERIA.abo.htm.* 

The incidence of induced abortion in Nigeria. *International Family Planning* 

abortion care: An expanded and updated model. *PAC in Action 2*, Special

from 1988-1998, *American Journal of Public Health*, 89, 579-586.

*drama of abortion*, Vanderbilt University Press, USA, 35.

*International Family Planning Perspectives*, 24, 30-38.

Development, Cairo, 1994. Paragraph 8.25.

Nigeria, UNFPA/Federal Ministry of Health, Abuja, Nigeria. 2003.

*Journal of Gynecology and Obstetrics*, 111, 53-56.

*Planning Perspectives*, 27, 2, 96-101.

consequences, Guttmacher Institutes, 4.

review of Nigeria, August 29 2008: 5.

*Matters*, 10, 13-17.

*Perspectives*, 22, 76-89.

*Perspectives*, 24, 156-164.

Supplement, September 2002.

Richardson, SS. (1933). Nigeria abortion law, In:

(Accessed July 15, 2011).

data. Geneva: WHO, 1998.

386-395.

counseling practiced by health professionals in southeastern Nigeria. *International* 

(2006).Unwanted pregnancy and induced abortion in Nigeria: causes and


Women centered post abortion care was developed in 2005 as a step forward from the original PAC. It is a comprehensive approach to meeting each woman's medical and psychosocial needs at the time of treatment for abortion complications. In course of providing women centered post abortion care by health care workers, factors influencing women's need for and access to care such as personal circumstances and living conditions are taken into cognizance to ensure quality service delivery.

PAC has found wide acceptability in developing countries as a very important tool in the combat of maternal mortality from abortion. In countries like Nigeria and Ghana, and many other developing countries of Asia, middle level providers especially Nurse-Midwives have been trained on PAC and have been employed widely in the provision of abortion treatment services especially in rural areas. In Nigeria, Medical Practitioners and Nurse-Midwives both in the private and public health facilities are being trained on the practice of PAC with tremendous success. PAC has also been incorporated by the Nursing and Midwifery Council of Nigeria into the training curriculum of midwifery in Nigeria. PAC training programmes however still need to be better streamlined and more intensified. In a recent survey of 437 health practitioners in southeastern Nigeria, comprising mostly of Doctors and Nurse-Midwives, as high as 75.5% of the respondents were aware of PAC, although only 35.5% used manual vacuum aspirator (MVA) (Adinma et al., 2010). In a related survey of 431 health care professionals in the same area, only 41% had been trained on PAC counseling (Adinma et al., 2010a, 2010b). These attest to the need for the intensification of PAC training programmes to widen the provision of PAC services to all parts of the country.

### **7. Conclusion**

The contribution of abortion to high maternal mortality in countries with restrictive abortion laws has made PAC services increasingly relevant particularly in these areas. PAC, for its individualized approach and simplicity of application have been found to be attractive even to middle level health care providers who are readily available in rural areas without the benefit of the services of Medical Doctors. The impact of PAC towards maternal mortality reduction is likely to become evident when a wide coverage of the services is achieved in countries where they are needed. This can be possible when such countries put in place a well packaged PAC training programme made available to all health care practitioners treating abortion to ensure quality services.

#### **8. References**

Adinma, JIB., Ikeako, L., Adinma, ED., Ezeama, CO., & Ugboaja, JO. (2010). Awareness and practice of post abortion care services among health care professionals in southeastern Nigeria. *The Southeast Asian J of Tropical Medicine and Public Health*, 41, 3, 696-704.

4. Contraceptive and family planning services to help women prevent an unwanted

5. Linkage to reproductive and other health services that are preferably provided on-site

Women centered post abortion care was developed in 2005 as a step forward from the original PAC. It is a comprehensive approach to meeting each woman's medical and psychosocial needs at the time of treatment for abortion complications. In course of providing women centered post abortion care by health care workers, factors influencing women's need for and access to care such as personal circumstances and living conditions

PAC has found wide acceptability in developing countries as a very important tool in the combat of maternal mortality from abortion. In countries like Nigeria and Ghana, and many other developing countries of Asia, middle level providers especially Nurse-Midwives have been trained on PAC and have been employed widely in the provision of abortion treatment services especially in rural areas. In Nigeria, Medical Practitioners and Nurse-Midwives both in the private and public health facilities are being trained on the practice of PAC with tremendous success. PAC has also been incorporated by the Nursing and Midwifery Council of Nigeria into the training curriculum of midwifery in Nigeria. PAC training programmes however still need to be better streamlined and more intensified. In a recent survey of 437 health practitioners in southeastern Nigeria, comprising mostly of Doctors and Nurse-Midwives, as high as 75.5% of the respondents were aware of PAC, although only 35.5% used manual vacuum aspirator (MVA) (Adinma et al., 2010). In a related survey of 431 health care professionals in the same area, only 41% had been trained on PAC counseling (Adinma et al., 2010a, 2010b). These attest to the need for the intensification of PAC training programmes to widen the provision of PAC services to all parts of the

The contribution of abortion to high maternal mortality in countries with restrictive abortion laws has made PAC services increasingly relevant particularly in these areas. PAC, for its individualized approach and simplicity of application have been found to be attractive even to middle level health care providers who are readily available in rural areas without the benefit of the services of Medical Doctors. The impact of PAC towards maternal mortality reduction is likely to become evident when a wide coverage of the services is achieved in countries where they are needed. This can be possible when such countries put in place a well packaged PAC training programme made available to all health care practitioners

Adinma, JIB., Ikeako, L., Adinma, ED., Ezeama, CO., & Ugboaja, JO. (2010). Awareness and

practice of post abortion care services among health care professionals in southeastern Nigeria. *The Southeast Asian J of Tropical Medicine and Public Health*, 41, 3, 696-704.

or via referrals to other accessible facilities in the providers' networks.

pregnancy or practice birth spacing; and

are taken into cognizance to ensure quality service delivery.

country.

**7. Conclusion** 

**8. References** 

treating abortion to ensure quality services.


**8** 

Mats Fagerquist

*Sweden* 

**Renal Function and Urine Production in** 

Fetal urine production begins in the first trimester. Autopsy findings of filled urinary bladders in human fetuses have been reported from 11 gestational weeks (Abramovich, 1968). In 1970, the first report on ultrasound investigations of the fetal urinary bladder was published (Garrett et al., 1970). Three years later, a method for estimating fetal urine

In this paper, a short summary of amniotic fluid turnover is presented. Moreover, fetal renal development, artery flow velocity and urine production in normal and compromised fetuses are dealt with. The gradual development of the 2D ultrasound technique for estimating of the fetal urine production rate (HFUPR) is described. In addition, some confounding factors are mentioned. Finally, two important clinical questions, which must be taken into

The volume of amniotic fluid increases during pregnancy (Queenan et al., 1972). In general, the secretion of liquid by the kidneys and from the fetal lungs and oro-nasal cavity is balanced by the removal of equal amounts of liquid (Flack et al., 1995). The main clearance pathway is the swallowing of fluid by the fetus. Additionally, albeit to a lesser degree, fluid passes from the amniotic lumen via the surfaces of the placenta and umbilical cord into the fetal blood circulation (the intramembranous pathway) and into the mother's circulation (the transmembranous pathway) via the uterine wall through the surface of the amniotic sac

Oligohydramnios (reduced volume < 300 mL) is found in 3-5% (Hansmann, 1985; Volante et al., 2004). Rupture of the membranes is the most common cause of oligohydramnios. A reduction in amniotic fluid volume is of particular concern when it occurs in conjunction with structural fetal anomalies, fetal growth restriction, kidney abnormalities, postdate pregnancies and maternal disease. In these high-risk conditions, it is associated with a poor perinatal outcome (Camanni et al., 2009; Hill et al., 1983). Early onset of oligohydramnios

consideration when utilising the HFUPR for fetal surveillance, are identified.

**1. Introduction** 

**2. Amniotic fluid** 

outside the placental border.

**2.1 Abnormal amounts of amniotic fluid** 

production was introduced (Campbell et al., 1973).

**the Compromised Fetus** 

*North Elfsborg County Hospital, Trollhattan* 

World Health Organization. (1994). Mother-Baby-Package: implementing safe motherhood in countries. Practical Guide. Maternal health and safe motherhood programmes, Division of Family Health, WHO, Geneva. 1994.
