Factors Associated with Abortion Complications after the Implementation of a Surveillance Network (MUSA Network) in a University Hospital

Abstract

Objective To evaluate the factors associated with abortion complications following the implementation of the good-practice surveillance network Mujeres en Situación de Aborto (Women Undergoing Abortion, MUSA, in Spanish). Methods A cross-sectional study with women who underwent abortion due to any cause and in any age group at UNICAMP Women's Hospital (part of MUSA network), Campinas, Brazil, between July 2017 and Agust 2019. The dependent variable was the presence of any abortion-related complications during hospitalization. The independent variables were clinical and sociodemographic data. The Chi-square test, the Mann–Whitney test, and multiple logistic regression were used for the statistical analysis. Results Overall, 305 women were enrolled (mean ± standard deviation [SD] for age: 29.79 ± 7.54 years). The mean gestational age was 11.17 (±3.63) weeks. Accidental pregnancy occurred in 196 (64.5%) cases, 91 (29.8%) due to contraception failure. At least 1 complication was observed in 23 (7.54%) women, and 8 (34.8%) of them had more than 1. The most frequent complications were excessive bleeding and infection. The factors independently associated with a higher prevalence of complications were higher gestational ages (odds ratio [OR]: 1.22; 95% confidence interval [95%CI]: 1.09 to 1.37) and contraceptive failure (OR: 3.4; 95%CI: 1.32 to 8.71). Conclusion Higher gestational age and contraceptive failure were associated with a higher prevalence of complications. This information obtained through the surveillance network can be used to improve care, particularly in women more susceptible to unfavorable outcomes.

The Impact of the COVID-19 Pandemic on the Care of Women Experiencing Abortion in a University Hospital in Brazil

“…16,17 Besides, failure of contraceptive methods might reflect the contraceptive use pattern of our country, in which oral contraceptives and condom are predominant compared with long-acting reversible contraceptives, such as intrauterine devices. 13 Our study showed that each week of gestational age increased 12.6% the risk of complications, while another study showed an increase in the number of complications by up to 20% in each week. 18 Pregnancies with higher gestational ages mean higher uterine volume, bigger amount of retained products of conception, and possible chorioamnionitis.…”

“…During the PrP, it was observed that the mean maternal age was 30. 13 In the PrP, 60.93% of the patients were married or living in a stable relationship, while 51.65% in the PP were single (p ¼ 0.005). In the PrP, 91.96% of patients did not have comorbidities, compared with 96.74% in the PP (p ¼ 0.031).…”

“…The hospital follows the laws of Brazil regarding the legal termination of pregnancy, in which abortion is allowed only in cases of risk of maternal death, sexual violence, and fetal anencephaly. [7][8][9][10][11][12][13][14][15][16][17][18][19] The sentinel centers of the MUSA network regularly provide information on maternal morbidity in early pregnancy loss, termination methods for uterine evacuations, incidence of complications related to pregnancy termination, incidence of preoperative antibiotic use and prescription of contraception before hospital discharge. Through SIP, it is possible to carry out epidemiological monitoring and comparisons between different sentinel centers over time.…”

Building a network of sentinel centres for the care of women in an abortion situation: advances in Latin America and the Caribbean

“…The authors identified that the factors associated with the presence of complications were higher gestational age and abortions resulting from contraceptive failure. It is noteworthy that approximately 30% of women became pregnant despite contraceptive use 22. In the same publication, the authors reported an approximate 90% rate of need for a uterine evacuation procedure, with a high rate of use of curettage and a dual method for uterine evacuation (misoprostol and curettage).…”

“…It is noteworthy that approximately 30% of women became pregnant despite contraceptive use. 22 In the same publication, the authors reported an approximate 90% rate of need for a uterine evacuation procedure, with a high rate of use of curettage and a dual method for uterine evacuation (misoprostol and curettage). Aiming to analyse the effects of participation in the CLAP MUSA-Network on the use of safer methods, this same sentinel centre performed trend analyses of the use of MVA and medical abortion among 474 women and reported an increased use of MVA; medical abortion, however, remained less used.…”