Trends in misoprostol use and abortion complications: A cross-sectional study from nine referral hospitals in Nigeria.

Folasade Adenike Bello,Bela Ganatra,Ibraheem Awowole,Babawale Oluborode,Theresa Irinyenikan,David Awonuga,Philip Guest,Bukola Fawole,Adetokunbo Fabamwo,Olabisi Loto,Clement A Adebamowo

doi:10.1371/journal.pone.0209415

Folasade Adenike Bello, Bela Ganatra + Show 9 more

Open Access

https://doi.org/10.1371/journal.pone.0209415

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Abstract

ObjectiveThe study aimed to assess the use of misoprostol and complications associated with abortions in referral hospitals in Nigeria, a country with restrictive abortion laws.MethodsA cross-sectional study at nine referral hospitals in South-west Nigeria. Nine years’ data were retrieved from medical records, including 699 induced abortions. Independent variable was the method of abortion; dependent variables were complications, need for treatment and mortality. Statistical significance was tested with Chi-square, Fishers’ exact and chi-square for trend tests (p<0.05).ResultsThere were 699 induced abortions amongst 2,463 abortions found in records. Nearly 70% were surgical abortions, but misoprostol use significantly increased over the study period in a linear trend (Χ2 trend: 30.96, P <0.001). Patients who used misoprostol were significantly less likely to have infectious morbidity, genital tract injuries or medical complications. There was no difference in incomplete abortion in the groups. Patients were more likely to have in-patient care with surgical abortions (p<0.001), to need prolonged antibiotic regimens (p = 0.003), need further surgeries or additional specialist care (p = 0.009).ConclusionMisoprostol abortion has significantly increased over time, and was associated with less morbidity and need for further treatment, in this study. It appears to be the safer option.

Highlights

A woman’s sexual and reproductive health rights include the ability to have a satisfying and safe sex life while retaining the liberty to prevent pregnancy if it is undesirable [1]
Even when contraception is available, it is apparent that a lot of advocacy is still required: some women consider contraception to be unsafe, avoid using it, and paradoxically consider seeking an abortion for an unwanted pregnancy to be safer than preventing it with a family planning method [3,4]
Research approval was obtained from the Institutional Research Boards covering all the participating centers and from the World Health Organization (WHO) Ethics Review Committee

Summary

Introduction

A woman’s sexual and reproductive health rights include the ability to have a satisfying and safe sex life while retaining the liberty to prevent pregnancy if it is undesirable [1]. Even when contraception is available, it is apparent that a lot of advocacy is still required: some women consider contraception to be unsafe, avoid using it, and paradoxically consider seeking an abortion for an unwanted pregnancy to be safer than preventing it with a family planning method [3,4]. Women in countries like Nigeria, which have restrictive abortion laws, end up seeking illegal abortions, which are often unsafe, because those medically qualified to do them usually do not [5]. Figures range widely, depending on the population studied: 3.25% of university undergraduates, [7]; 33.5% of women surveyed from the community [8] and 62% of women surveyed at a health care facility [9] had previously had an induced abortion. Two local medical facility-based studies of maternal deaths found that 11.5% and 30.8%, respectively could be attributed to abortion [11,13]

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