Treatment Of Abortion Complications Research Articles

Effects of implementing a postabortion care strategy in Kinshasa referral hospitals, Democratic Republic of the Congo

ObjectivesTo evaluate the effects of the implementation of a postabortion care (PAC) strategy in Kinshasa referral hospitals, this study analyzed the quality of postabortion care services, including postabortion contraception, and the duration of hospitalization.MethodologyWe estimated the effects of the PAC strategy using a quasi-experimental study by evaluating the outcomes of 334 patients with the diagnosis of a complication of induced abortion admitted to 10 hospitals in which the PAC strategy was implemented compared to the same outcomes in 314 patients with the same diagnosis admitted to 10 control facilities from 01/01/2016 to 12/31/2018. In response to government policy, the PAC strategy included the treatment of abortion complications with recommended uterine evacuation technology, the family planning counseling and service provision, linkages with other reproductive health services, including STI evaluation and HIV counseling and/or referral for testing, and partnerships between providers and communities. The information was collected using a questionnaire and stored using open data kit software. We supplemented this information with data abstracted from patient records, facility registries of gynecological obstetrical emergencies, and family planning registries. We analyzed data and developed regression models using STATA15. Thus, we compared changes in use of specific treatments and duration of hospitalization using a "difference-in-differences" analysis.ResultsThe implementation of PAC strategy in Kinshasa referral hospitals has resulted in the utilization of WHO recommended uterine evacuation method MVA (29.3% more in the experimental structures, p = 0.025), a non-significant decline in sharp-curettage (19.3% less, p = 0.132), and a decline in the duration of hospitalization of patients admitted for PAC (1 day less, p = 0.020). We did not observe any change in the use of PAC services, mortality, and the provision of post abortion contraception.ConclusionDespite significant improvement in the management of PAC, the uptake in WHO approved technology—namely MVA, and the duration of hospitalization, these outcomes while a significant improvement for DRC, indicate that additional quality improvement strategies for management of PAC and risk-mitigating strategies to reduce barriers to care are required.

Atención post aborto en el primer nivel de referencia de salud en Guatemala

Recibido: 28 ene. 2019 Aceptado: 14 may. 2019
 Objetivo: Introducir la atención post aborto en Centros de Atención Permanente (CAP) para mejorar el acceso al servicio y fortalecer la capacidad instalada del sistema de salud en áreas de población indígena desatendidas.
 Método: De abril 2014 a marzo 2016, se desarrolló un estudio piloto que incluyó 247 mujeres que presentaron complicaciones por aborto. Ningún tratamiento para las complicaciones por aborto era ofrecido antes en estos servicios. Capacitación clínica, en técnica de Aspiración Manual Endouterina (AMEU) y un sistema de monitoreo y evaluación fue implementado.
 Resultados: Doscientas treinta y dos (94%) de las mujeres con aborto incompleto fueron tratadas en los servicios con AMEU, no disponible antesen el servicio, 65% de los procedimientos fueron realizados bajo anestesia para-cervical, 20% con analgesia y sedación y 15% no requirió ningúnmedicamento, más que la consejería ofrecida durante el tratamiento.
 Diez y siete por ciento de las pacientes fueron adolescentes menores de 19 años y el mayor grupo atendido por complicaciones del aborto fueron mujeres entre 20 y 24 años (26%). Estos dos grupos juntos representan el 43% de la población asistida a nivel comunitario. Setenta y cuatro por ciento de las mujeres recibieron consejería sobre métodos anticonceptivos antes y después del procedimiento quirúrgico y el 57% aceptó un método anticontraceptivo antes delegreso.
 Conclusiones: El fortalecimiento institucional fue exitoso para la institucionalización de los servicios post aborto. Más del 40% de las pacientes tratadas a nivel comunitario son adolescentes con vida sexual activa y sin información y/o acceso a servicios que ofrezcan métodos anticontraceptivos efectivos.

What contraception do women use after experiencing complications from abortion? an analysis of cohort records of 18,688 postabortion care clients in Tanzania

BackgroundThe family planning component of postabortion care (PAC) is critical, as it helps women to prevent unintended pregnancies and reduce future incidence of life-threatening unsafe abortion. In Tanzania, PAC was recently decentralized from tertiary-level district hospitals to primary health care dispensaries in four regions of the country. This analysis describes interventions used to improve access to high quality PAC services during decentralization; examines results and factors that contribute to PAC clients’ voluntary uptake of contraception; and develops recommendations for improving postabortion contraceptive services.MethodsThis analysis uses service delivery statistics of 18,688 PAC clients compiled from 120 facilities in Tanzania between 2005 and 2014.ResultsThis study suggests that efforts to integrate postabortion family planning into treatment for incomplete abortion contributed to higher postabortion contraceptive uptake (86%). Results indicate that variables associated with significant differences in contraceptive uptake were facility level, age, gestational age at the time of treatment, and uterine evacuation technology used.ConclusionThe experience of expanding PAC services in Tanzania suggests that integrating contraceptive services with treatment for abortion complications can increase family planning use.

Complications with use of misoprostol for abortion in Madagascar: between ease of access and lack of information

ObjectiveThe objective was to learn what complications some women experienced in Madagascar following use of misoprostol for abortion and what treatment they received post misoprostol use. Study designThis was a qualitative study in 2015–2016 among women who had experienced complications after use of misoprostol, with or without additional methods, for abortion; what information they received before use; what dosage and regimens they used; what complications they experienced; and what treatment they received postuse. We initially conducted in-depth, semistructured interviews with 60 women who had undergone an abortion that resulted in complications. The results presented here are based on interviews with the subset of 19 women who had used misoprostol. ResultsThe 19 women were aged 16–40, with an average age of 21–26 at interview and average age of 18–21 at abortion. To obtain an abortion, they sought advice from partners, friends, family members, and/or traditional practitioners and health care providers. Misoprostol was easily accessible through the formal and informal sectors, but the dosages and regimens the women used on the advice of others were extremely variable, did not match WHO guidelines and were apparently ineffective, resulting in failed abortion, incomplete abortion, heavy bleeding/hemorrhage, strong pain and/or infection. ConclusionsThis study provides data on complications from the use of misoprostol as an abortifacient in Madagascar. Health care providers need training in correct misoprostol use and how to treat complications. Law and policy reforms are needed to support such training and to ensure the provision of safe abortion services in the public health system. ImplicationsHealth care providers who provide abortion care and treatment of abortion complications need training in correct misoprostol use and treatment of complications. Women and pharmacy workers also need this information. Law and policy reforms are needed to allow training and provision of safe services. Further research is needed on the extent and impact of incorrect misoprostol administration.

Safe Abortion Care, Utilization of Post Abortion Contraception and associated Factors, Jimma Ethiopia

Background: Each year, throughout the world, approximately 210 million women became pregnant and around one in 10 pregnancies end in an unsafe abortion. The interventions to prevent unsafe abortion and its complications include providing safe abortion service, treatment of abortion complications and access to modern contraceptive services. In Ethiopia and the study area in particular, availability of safe abortion care (SAC) and utilization of post abortion family planning is not well documented. Objective: To assess the availability of safe abortion care utilization of post abortion contraception and associated factors in Jimma town, south west Ethiopia. Methods and Materials: A facility based cross sectional study design was implemented from December 2015 to January 2016 in public, NGO and private health facilities of Jimma town. Women seeking abortion care services were interviewed using structured questionnaire and purposefully selected key informants including facility heads service providers and MCH head from the town health office were also interviewed using interview guides. Checklist assisted service observation and health facility audit was conducted. Epi Data version 3.1 is used for data entry and SPSS version 20.0 for analysis. Results: From 184 post abortion clients, 98(53.3%) were between 18-24 years of age, for 109(59.2%) education level is high school and above, 75(40.8%) and 23(30.7%) had history of previous pregnancy and abortion respectively. In this study, safe abortion care is found available in 6 health facilities 2 hospitals, 1 health center, 2 NGO, and 1 private clinic. Two of the health facilities were categorized as comprehensive and four others as basic safe abortion centers. The other two were categorized as non basic SAC facilities. Post abortion family planning utilization is 70.1%. From a total of 385 abortion related services during the three month from November 2015 to January 2016, 43(11.2%) were directed to treatment of abortion related complications. Severe abortion complications accounts 6(1.5%) of these complications and 1(0.2%) was reported to be resulted from unsafely terminated pregnancy. Age 18-24 years (AOR 95% CI: 9.308(2.817, 30.754)), married (AOR 95% CI: 6.711(1.099, 40.963)), having good awareness about the SAC services (AOR 95% CI: 4.594(1.185, 17.818)) were associated with PAFP utilization. Conclusion and Recommendation: In this study, more than quarter of the clients left the health facilities without post abortion family planning (PAFP). This is calling for action to scale up the counselling services, avail full options of contraception and raise awareness of the community on prevention and consequences of unwanted pregnancy and resulting abortion related complications.

Estimates of the magnitude and cost of treatment of abortion complications in public hospitals in Sierra Leone

Estimates of the magnitude and cost of treatment of abortion complications in public hospitals in Sierra Leone

Rewriting abortion: Deploying medical records in jurisdictional negotiation over a forbidden practice in Senegal

Boundary work refers to the strategies deployed by professionals in the arenas of the public, the law and the workplace to define and defend jurisdictional authority. Little attention has been directed to the role of documents in negotiating professional claims. While boundary work over induced abortion has been extensively documented, few studies have examined jurisdictional disputes over the treatment of abortion complications, or post-abortion care (PAC). This study explores how medical providers deploy medical records in boundary work over the treatment of complications of spontaneous and induced abortion in Senegal, where induced abortion is prohibited under any circumstance. Findings are based on an institutional ethnography of Senegal's national PAC program over a period of 13 months between 2010 and 2011. Data collection methods included in-depth interviews with 36 health care professionals, observation of PAC services at three hospitals, a review of abortion records at each hospital, and a case review of illegal abortions prosecuted by the state. Findings show that health providers produce a particular account of the type of abortion treated through a series of practices such as the patient interview and the clinical exam. Providers obscure induced abortion in medical documents in three ways: the use of terminology that does not differentiate between induced and spontaneous abortion in PAC registers, the omission of data on the type of abortion altogether in PAC registers, and reporting the total number but not the type of abortions treated in hospital data transmitted to state health authorities. The obscuration of suspected induced abortion in the record permits providers to circumvent police inquiry at the hospital. PAC has been implemented in approximately 50 countries worldwide. This study demonstrates the need for additional research on how medical professionals negotiate conflicting medical and legal obligations in the daily practice of treating abortion complications.

Health-related quality of life and social support among women treated for abortion complications in western Uganda

BackgroundWhile the impact of abortion complications on clinical outcomes and healthcare costs has been reported, we found no reports of their impact on Health-Related Quality of Life (HRQoL), nor the role of social support in moderating such outcomes. In this study, we performed an assessment of the relationship between abortion complications, HRQoL and social support among women in Uganda.MethodsWe interviewed women who were discharged after treatment for abortion complications and, as a comparison, women visiting a regional referral hospital for routine obstetric care. We administered the EuroQol instrument and the Social Support Questionnaire Short-Form, and collected demographic and socioeconomic data. We performed descriptive analyses using t-tests, Wilcoxon rank-sum tests and chi-square tests, and multivariable linear regressions with interaction effects to examine the associations between abortion complications, EQ-5D utility scores and social support.ResultsOur study included 139 women (70 with abortion complications, and 69 receiving routine obstetric care). In four out of the 5 dimensions of the EQ-5D, a larger proportion of women with abortion complications reported “some or severe” problems than women receiving routine obstetric care (self-care: 42% v 24%, p=0.033; usual activities: 49% v 16%, p<0.001; pain/discomfort: 68% v 25%, p<0.001; and anxiety/depression: 60% v 22%, p<0.001). After adjusting for age, social support, wealth tertile, employment status, marital status, and HIV status, women with abortion complications had a 0.12 (95% CI: 0.07, 0.18, p < 0.001) lower mean EQ-5D utility score than those receiving routine obstetric care. An analysis of the modifying effect of social support showed that a one-unit higher average number of people providing social support was associated with larger mean difference in EQ-5D utility score when comparing the two groups, while a one unit higher average satisfaction score with social support was associated with smaller mean differences in EQ-5D utility score.ConclusionsOur study suggests that abortion complications are associated with diminished HRQoL and the magnitude of the association depends on social support. However, the mediating role of social support in a setting of social and legal proscriptions to induced abortion is complex.

Public hospital costs of treatment of abortion complications in Nigeria

Unsafe abortion is a significant contributor to maternal mortality in Nigeria, and treatment of postabortion complications drains public healthcare resources. Provider estimates of medications, supplies, and staff time spent in 17 public hospitals were used to estimate the per-case and annual costs of postabortion care (PAC) provision in Ogun and Lagos states and the Federal Capital Territory. PAC with treatment of moderate complications (US $112) cost 60% more per case than simple PAC (US $70). In cases needing simple PAC, treatment with dilation and curettage (D&C, US $80) cost 18% more per case than manual vacuum aspiration (US $68). Annually, all public hospitals in these 3 states spend US $807 442 on PAC. This cost could be reduced by shifting service provision to an outpatient basis, allowing service provision by midwives, and abandoning the use of D&C. Availability of safe, legal abortion would further decrease cost and reduce preventable deaths from unsafe abortion.

Postabortion care in Latin America: policy and service recommendations from a decade of operations research

Unsafe abortion contributes significantly to maternal mortality and morbidity in Latin America. Postabortion care (PAC) using preferred technologies and a woman-centred approach to treat the complications of unsafe abortion can save women's lives and improve their reproductive health, as well as reduce costs to health systems. This article reviews results from 10 major PAC operations research projects conducted in public sector hospitals in seven Latin American countries, completed and published between 1991 and 2002. The studies show that following relatively modest interventions, the majority of eligible patients were being treated with manual vacuum aspiration (MVA), a method preferred for safety and other reasons over the method conventionally used in the region, sharp curettage (SC). A number of studies showed improvements in contraceptive counselling and services when these were integrated with clinical treatment of abortion complications, resulting in substantial increases in contraceptive acceptance. Finally, data from several studies showed that, in most settings, reorganizing services by moving treatment out of the operating theatre and reclassifying treatment as an ambulatory care procedure substantially reduced the resources used for PAC, as well as the cost and average length of women's stay in the hospital. These studies suggest that comprehensive PAC can and should be available to all women in Latin America. Such efforts should be coupled with work to improve primary prevention, including better contraceptive services to prevent unwanted pregnancy and safe, legal abortion services to reduce the number of clandestine and unsafe abortions.