A prospective descriptive study of the management of miscarriages at two tertiary hospitals in Zimbabwe: variations from global trends

Abstract

Background: Early pregnancy loss is the commonest reason for admission to gynaecological wards for women of reproductive age group.Objective: To assess the current management of incomplete miscarriage at Harare and Parirenyatwa Hospitals and to determine the proportion of patients with incomplete miscarriage managed with Manual Vacuum Aspiration (MVA), sharp curettage or medical evacuation.Design: A prospective descriptive study.Setting: Two teaching hospitals in Zimbabwe.Materials and Methods: Women admitted with incomplete miscarriage, missed, septic incomplete and complete miscarriage were followed up from admission until discharge between for April and May in 2014. Demographic details, management and clinical course was recorded prospectively on a form.Main Outcome Measures: Outcome assessed were method of evacuation, need for transfusion, antibiotic use and hospital stay.Results: Four hundred and eleven (411) women were admitted to the two hospitals. The mean gestation at admission was 12 weeks. Planned pregnancies were 62.3% with 37.8% unplanned. Those who used contraception prior to conception were 22%. Only 5.4% were diagnosed as septic and 2 patients (0.5%) had foreign bodies in the genital tract. The majority of patients had sharp curettage for evacuation of retained products of conception with very few patients being having MVA, suction curettage, expectant management or medical evacuation. Overall only 0.5% of patients had medical evacuation. The mean duration of hospital stay was 27 and 19 hours for Parirenyatwa and Harare respectively and was not statistically significant.Conclusion: We have shown that most patients are still having sharp curettage in theatre despite Zimbabwe being one of the countries to introduce MVA in early 1990s. Management of incomplete miscarriage has not kept up with global trends where suction blunt curettage is the preferred method