Abstract
BackgroundComplications of unsafe abortion are a major contributor to maternal deaths in developing countries. This study aimed to evaluate the clinical assessment for life-threatening complications and the following management in women admitted with complications from abortions at a rural hospital in Uganda.MethodsA partially completed criterion-based audit was conducted comparing actual to optimal care. The audit criteria cover initial clinical assessment of vital signs and management of common severe complications such as sepsis and haemorrhage. Sepsis shall be managed by immediate evacuation of the uterus and antibiotics in relation to and after surgical management. Shock by aggressive rehydration followed by evacuation.In total 238 women admitted between January 2007 and April 2012 were included. Complications were categorized as incomplete, threatened, inevitable, missed or septic abortion and by trimester. Actual management was compared to the audit criteria and presented by descriptive statistics.ResultsFifty six per cent of the women were in second trimester. Abortion complications were distributed as follows: 53 % incomplete abortions, 28 % threatened abortions, 12 % inevitable abortions, 4 % missed abortions and 3 % septic abortions. Only one of 238 cases met all criteria of optimal clinical assessment and management. Thus, vital signs were measured in 3 %, antibiotic criteria was met in 59 % of the cases, intravenous fluid resuscitation was administered to 35 % of women with hypotension and pain was managed in 87 % of the cases. Sharp curettage was used in 69 % of those surgically evacuated and manual vacuum aspiration in 14 %. In total 3 % of the abortions were categorized as unsafe. Two of eight women with septic abortion had evacuation performed during admission-day, one woman died due to septic abortion and one from severe haemorrhage.ConclusionsGuidelines were not followed and suboptimal assessment or management was observed in all but one case. This was especially due to missing documentation of vital signs necessary to diagnose life-threatening complications, poor fluid resuscitation at signs of shock, and delayed evacuation of septic abortion.
Highlights
Complications of unsafe abortion are a major contributor to maternal deaths in developing countries
More than one in five had previously had an abortion and 55.5 % of the women were in second trimester mainly according to last menstrual period
In this case Sharp curettage (SC) was postponed until two days after admission. Another woman died due to haemorrhage she received fluid resuscitation and blood transfusions, but she had no evacuation of the retained products. This is to our knowledge the only partially completed Criterion-based audit (CBA) study evaluating the quality of clinical assessment for life-threatening complications and management of abortion related complications in a low-income country
Summary
Complications of unsafe abortion are a major contributor to maternal deaths in developing countries. Complications of abortion is the second highest cause of maternal death worldwide and may cause 13 % of all pregnancy-related deaths [1, 2]. 21 of 200 million annual pregnancies are terminated by unsafe abortion [1]. This figure has remained unchanged for the last decades [3]. The World Health Organization (WHO) defines unsafe abortion as ‘a procedure for terminating an unintended pregnancy either by individuals without the necessary skills. In Uganda, as in the majority of SubSaharan African countries, induced abortion is illegal
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