Family Medicine & Primary Care Review 2019; 21(1): 23–29 https://doi.org/10.5114/fmpcr.2019.82975 ISSN 1734-3402, eISSN 2449-8580 ORIGINAL PAPERS © Copyright by Wydawnictwo Continuo The seven-year epidemiological study of legal abortion caused by heart disease, blood disorders, diabetes and hypertension as referred to forensic medicine centers in Fars Province FATEMEH GHODRATI1, A, D, E, F, NARJES SAADATMAND2, B, D, F, SAEID GHOLAMZADEH3, D, F, MARZIEH AKBARZADEH4, A, C–F ORCID ID: 0000-0002-4491-2437 1 Department of Theology, Faculty of Humanities Science College, Yasouj University, Yasouj, Iran 2 Department of Midwifery, Student Research Committee, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran 3 Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran 4 Maternal-Fetal Medicine Research Center, Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran A – Study Design, B – Data Collection, C – Statistical Analysis,D – Data Interpretation,E – Manuscript Preparation,F – Literature Search, G – Funds Collection Summary Background. Chronic diseases such as uncontrolled diabetes, some types of heart disease, and hypertension are of the most common risk factors for high risk pregnancies and spontaneous or therapeutic abortions. Objectives. To investigate the legal abortion caused by heart disease, blood disorders, diabetes and hypertension as referred to foren- sic medicine centers in Fars Province from 2007 to 2013. Material and methods. In a retrospective, cross-sectional study, samples consisted of all documents of people referred to forensic medicine centers in Shiraz since 2007 to 2013, comprising of 1664 files. Data collection tools included a demographic forum and the checklist of abortion causes. SPSS.16.0 was applied to analyze the data through descriptive statistical analysis. Results. The most frequent age group was 25–29 years at 31.5% (n = 522) and the lowest was over 40 years old at 4.15% (n = 70). The statistical report of the reasons for legal abortion permission were 19% (n = 63), 24.4% (n = 81), 10.54% (n = 35), and 8.13% (n = 27) due to heart problems, blood disorders, hypertension, and diabetes mellitus, respectively. Most frequent legal abortion permits by foren- sic medicine due to maternal causes were between the years of 2011–2012 at 17.8–28% (n = 59–93). The relationship between legal abortion permission at The Forensic Medicine Center at different years and maternal ages was statistically significant (p < 0.00001). Conclusions. The most common prevalent reason of abortion was Blood Disorder – 81 patients (24.4%) and heart disease – 63 cases (19%). It is essential that family education and prevention of repeated pregnancies be done with high-risk women. Also, initiation of pregnancy care at lower gestational age in identifying risky pregnancies and timely control of complications must also be undertaken. Key words: heart diseases, diabetes mellitus, hypertension, abortion, legal. Ghodrati F, Saadatmand N, Gholamzadeh S, Akbarzadeh M. The seven-year epidemiological study of legal abortion caused by heart disease, blood disorders, diabetes and hypertension as referred to forensic medicine centers in Fars Province. Fam Med Prim Care Rev 2019; 21(1): 23–29, doi: https://doi.org/10.5114/fmpcr.2019.82975. Background is the result of pregnancy termination, usually before the embryo or fetus is capable of independent life (outside the womb) [6]. A WHO Insecure abortion is still one of the main reasons for the meta-analysis shows that the most important direct causes of ma- death of mothers, accounting for 14.5% of all maternal deaths ternal death are bleeding, high blood pressure, miscarriage and in- globally [1]. fection. In addition, both postpartum and antepartum depression The General Assembly, attended by the leaders of 189 coun- are considered as the premier pregnancy related complication [7]. tries, signed a statement on the eight Millennium Development In the Islamic Republic of Iran, abortion of a fetus is restricted Goals in 2000, the intent of which was to improve the lives of wom- to certain legal and religious conditions, but at the moment, despite en, men and children [2]. The agreement demanded a reduction in these conditions, a number of people attempt abortion using secret the world’s maternal mortality ratio by 75% from 1990 to 2015. illegal and unhealthy methods that in some cases, come with failure Therein, absolute prevention and reduction in maternal mortality or even serious complications for the mother and fetus [8, 9]. was introduced as an indicator of maternal health progress [3]. The When continuation of pregnancy threatens the mother’s life maternal mortality ratio is, hence, the most important indicator or health or exacerbates her disease complications, therapeutic that reflects the situation of progress. abortion is a solution enabled by legal permission and medical fo- In most developing countries, mortality, pregnancy-related rensic certification. Fetal abortion is not acceptable in Iran and other complications and childbirth are considered as the first causes of Islamic religions except for medical conditions or when the health death and disability among women aged 15 to 49 years [4]. Abor- of the mother is at risk [10]. Currently, there are various legislations tion in non-standard and illegal conditions is still considered as the as to fetal abortion. Moreover, religious, cultural, and moral be- first cause of maternal death in developing countries [5]. Abortion liefs are effective in the implementation of abortion law [11]. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0). License (http://creativecommons.org/licenses/by-nc-sa/4.0/). 24 F. Ghodrati et al. • Legal abortion in high risk pregnancy The right to liberty, moral strategy [12] and the right to re- which was conducted on the prevalence of GDM in Iran, states productive health [13] are of the major human rights that are that the prevalence of GDM was reported between 1.3 percent sometimes used as a justification for the presence or absence and 8.9 percent in different areas in Iran in 2008. Its prevalence of abortion supervisory approaches. Annually, the occurrence was 4.4 percent in women without risk factors in Tehran and 10 of abortion is about 46 million worldwide. About half of these percent in women having at least one risk factor [29]. According abortions occur in developing countries and are mostly unsafe to the results of another study, Asians were identified as the [14]. There are no official statistics on abortion in Iran; several race at high risk for gestational diabetes. However, there are dif- studies have reported 80,000 abortions per year [15]. Other ferent statistics due to the variety of races and ethnicities, -dif studies have shown that induced and unsafe abortions engen- ferences in lifestyle and nutrition, socio-economic status, lack of der serious complications such as maternal mortality, uterine an equal protocol for diagnosis and screening [30]. Stillbirth (fe- rupture and sepsis [16]. tal death at or after 20 to 28 weeks of pregnancy), miscarriage, At different times, several threatening risk factors come pre-eclampsia, and macrosomia were reported in the studies on about during pregnancy. The classification of high-risk pregnan- patients with gestational diabetes [31]. cies include maternal underlying disease, socioeconomic fac- Hypertension differences were also major causes (preva- tors, the history of risk factors in previous pregnancies and the lence of 5.9%) of maternal death during pregnancy [32]. The risk factors associated with the current pregnancy that may oc- study conducted by Mettu and Ethiopia reveals that the preva- lence of hypertensive disorder was 2.4% in 2010–2013. The ma- cur during it [17]. The prevalence of high-risk pregnancies var- jority of women afflicted (82.6%) were 18 and 34 years old. ies from country to country, for example, in northern India, it is Fetal complications included abortion (10.7%), preterm 31.4% [18] and in Tunisia – 59.5% [19]. Moreover, it is reported birth (31.4%), and birth death (120.37 cases in 1000 births) [33]. that the prevalence of high-risk pregnancies varies in different Increased permitted therapeutic abortion leads to transfer of regions of Iran [20]. abortion laws from the field of crime to health and welfare [34]. Pregnancy is stressful for the mother even in the best con- Repeated visits into forensic medicine centers for abortion and ditions. Such maternal stress and anxiety increases when it is lack of similar studies prompted us to do this study. Thus, this combined with unexpected maternal medical problems due to study aimed to investigate the legal abortion caused by heart underlying diseases, fetal illnesses that already exist or when disease, blood disorders, diabetes, and hypertension as referred it is combined with complications of pregnancy [17]. Women to forensic medicine centers in Fars Province since 2007 to 2013. who experience high-risk pregnancy may encounter physical, psychological and socioeconomic consequences imposed by the nature of treatment and the potential need for long-term Objectives care at home or in the hospital. They have to adapt their life- Primary purpose: To investigate the frequency of legal abor- style to the new situation, and, therefore, it is followed by the tion brought about by heart disease, blood disorders, diabetes, negative effects of stress and anxiety for themselves and their and hypertension and others. family [21]. Secondary purpose: To investigate the frequency of mater- Some studies that have reviewed the experiences of family nal cause of legal abortion in different parental age groups. planning service providers with regard to the causes of unwant- ed pregnancy report that issues such as “service provider sys- tem problems”, “service recipients features” and “capabilities Material and methods of family planning devices” are reasons for unwanted and un- planned pregnancy.