A prospective study of complications from comprehensive abortion care services in Nepal

Abstract

BackgroundIn March 2002, Nepal's Parliament approved legislation to permit abortion on request up to 12 weeks of pregnancy. Between 2004 and 2007, 176 comprehensive abortion care (CAC) service sites were established in Nepal, leading to a rise in safe, legal abortions. Though monitoring systems have been developed, reporting of complications has not always been complete or accurate. The purpose of this study was to report the frequency and type of abortion complications arising from CAC procedures in different types of facilities in Nepal.MethodsA total of 7,386 CAC clients from a sample of facilities across Nepal were enrolled over a three-month period in 2008. Data collection included an initial health questionnaire at the time of abortion care and a follow-up questionnaire assessing complications, administered two weeks after the abortion procedure. A total of 7,007 women (95%) were successfully followed up. Complication rates were assessed overall and by facility type. Multivariable logistic regression was used to assess the association between experiencing a complication and client demographic and facility characteristics.ResultsAmong the 7,007 clients who were successfully followed, only 1.87% (n = 131) experienced signs and symptoms of complications at the two-week follow up, the most common being retained products of conception (1.37%), suspected sepsis (0.39%), offensive discharge (0.51%) and moderate bleeding (0.26%). Women receiving care at non-governmental organization (NGO) facilities were less likely to experience complications than women at government facilities, adjusting for individual and facility characteristics (AOR = 0.18; 95% CI: 0.08-0.40). Compared to women receiving CAC at 4-5 weeks gestation, women at 10-12 weeks gestation were more likely to experience complications, adjusting for individual and facility characteristics (AOR = 4.21; 95% CI: 1.38-12.82).ConclusionsThe abortion complication rate in Nepali CAC facilities is low and similar to other settings; however, significant differences in complication rates were observed by facility type and gestational age. Interventions such as supportive supervision to improve providers' uterine evacuation skills and investment in equipment for infection control may lower complication rates in government facilities. In addition, there should be increased focus on early pregnancy detection and access to CAC services early in pregnancy in order to prevent complications.

Sociodemographic and reproductive profile of women with abortion complications in hospital in Recife

“…The restrictive laws in relation to abortion in most developing countries lead women to use unsafe practices of abortion, competing for a larger occurrence of infections and genital trauma. In this study, the major complication related to abortion was infection, and these data are consistent with other studies that were investigated to severe maternal morbidity associated with abortion 9,12 . The frequency of complications was higher among women with gestational age above 12 weeks and this may reflect the delay in recognizing the pregnancy as well as, the difficulty to access health services.…”

“…The frequency of complications was higher among women with gestational age above 12 weeks and this may reflect the delay in recognizing the pregnancy as well as, the difficulty to access health services. In contrast of this, other studies observed that complications were more frequent in early abortions 9,12 .…”

“…In this study, the complications were more frequent in women in the age group between 20 and 35 years, and this has been the age range most observed in the majority of studies on abortion complications in different regions 9,11 . In general, this is the predominant age group mostly studied on abortion or problems related to pregnancy, as it is considered the ideal age for reproduction.…”

“…It was observed in Thailand, a rate a bit higher with a percentage of 36.8% 9 . Such high rates on complications are found in countries where abortion is considered illegal, motivating women to use unsafe methods to interrupt an unwanted pregnancy 10 .…”

Clandestine Abortions in Cameroon: Risk Factors for Severe Complications

“…This is similar to other studies which found that increasing gestational age was associated with an increased risk of severe complication following induced abortion. 7,8 In our series, abortionists were mainly untrained health providers (nurses) in the SC group (49/76 or 64.5%) as already observed by others. 4,9 Abortions were performed mainly at abortionist's or patient's home (41.6%), in a health center (35.1%), in a private clinic (21.2%) and rarely in a hospital (2.1%).…”