A maternal death from self-induced medical abortion: a call for action.

Objectives: In Georgia, which has a longstanding, liberalised abortion law, the abortion procedure is generally safe if it is performed in a medical facility. However, when socioeconomic barriers prevent women from seeking safe abortion services, some risk their life by self-terminating an unintended pregnancy. We present a case of maternal mortality after a self-induced medical abortion, with the aim to investigate the underlying non-clinical causes of maternal death and the relevant policy implications. Case: A 34-year-old socially vulnerable woman self-administered 10 tablets of oral misoprostol to terminate an 18-week pregnancy. She expelled the fetus the following day. A week later, she developed excessive vaginal bleeding, difficulty in breathing and tachycardia. She was hospitalised and diagnosed with sepsis due to a retained placenta. Uterine curettage and aggressive conservative management, followed by total abdominal hysterectomy, failed to stop the fulminant septic process. The patient's condition deteriorated rapidly and she died 15 h after admission to hospital. Conclusion: Socially disadvantaged women in Georgia have limited access to safe abortion services, and some are impelled to self-induce abortion in order to terminate an unintended pregnancy. Inclusion of family planning and abortion services in the Universal Health Care benefits package for socially vulnerable families may reduce the morbidity and mortality associated with unsafe abortion practices.