Abstract
BackgroundMaternal mortality due to abortion complications stands among the three leading causes of maternal death in Botswana where there is a restrictive abortion law. This study aimed at assessing the patterns and determinants of post-abortion complications.MethodsA retrospective institution based cross-sectional study was conducted at four hospitals from January to August 2014. Data were extracted from patients’ records with regards to their socio-demographic variables, abortion complications and length of hospital stay. Descriptive statistics and bivariate analysis were employed.ResultA total of 619 patients’ records were reviewed with a mean (SD) age of 27.12 (5.97) years. The majority of abortions (95.5%) were reported to be spontaneous and 3.9% of the abortions were induced by the patient. Two thirds of the patients were admitted as their first visit to the hospitals and one third were referrals from other health facilities. Two thirds of the patients were admitted as a result of incomplete abortion followed by inevitable abortion (16.8%). Offensive vaginal discharge (17.9%), tender uterus (11.3%), septic shock (3.9%) and pelvic peritonitis (2.4%) were among the physical findings recorded on admission. Clinically detectable anaemia evidenced by pallor was found to be the leading major complication in 193 (31.2%) of the cases followed by hypovolemic and septic shock 65 (10.5%). There were a total of 9 abortion related deaths with a case fatality rate of 1.5%. Self-induced abortion and delayed uterine evacuation of more than six hours were found to have significant association with post-abortion complications (p-values of 0.018 and 0.035 respectively).ConclusionAbortion related complications and deaths are high in our setting where abortion is illegal. Mechanisms need to be devised in the health facilities to evacuate the uterus in good time whenever it is indicated and to be equipped to handle the fatal complications. There is an indication for clinical audit on post-abortion care to insure implementation of standard protocol and reduce complications.
Highlights
Post-abortion care and contraception are some of the oldest sexual and reproductive health care services, dating back to ancient Roman, Grecian and Egyptian history
Maternal mortality due to abortion complications stands among the three leading causes of maternal death in Botswana where there is a restrictive abortion law
There is an indication for clinical audit on post-abortion care to insure implementation of standard protocol and reduce complications
Summary
Post-abortion care and contraception are some of the oldest sexual and reproductive health care services, dating back to ancient Roman, Grecian and Egyptian history. Different abortion techniques used by Egyptians were documented in the ancient Ebers Papyrus in 1550 BC [1, 2]. Despite this unintended pregnancy due to an unmet need for contraception and unsafe abortion remains one of the leading causes of maternal death in the 21st Century. Countries with restrictive abortion laws carry the major share of this burden. In such situations it has been reported that one in four pregnancies are unintended; some countries have an unmet need as high as 51% leading to unintended pregnancy which is a major risk for unsafe induced abortion. This study aimed at assessing the patterns and determinants of post-abortion complications
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