High Levels of Post-Abortion Complication in a Setting Where Abortion Service Is Not Legalized

Melese, Tadele; Habte, Dereje; Tsima, Billy; Mogobe, Keitshokile Dintle; Chabaesele, Kesegofetse; Rankgoane, Goabaone; Keakabetse, Tshiamo R.; Masweu, Mabole; Mokotedi, Mosidi; Motana, Mpho; Moreri-Ntshabele, Badani

doi:10.1371/journal.pone.0166287

Cited by 36 publications

(45 citation statements)

References 25 publications

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“…This needs to be addressed as part of the elements of post abortion care and should be used as opportunity for HIV screening and prevention. As it was reported from our previous work, there was a high incidence of second trimester abortion[ 16 ]. Such second trimester post abortion care is known to be more demanding in terms of resources because of increased maternal near miss or death according to WHO multicenter study[ 18 ].…”

Section: Discussionsupporting

confidence: 54%

“…The management of post-abortion complications among 619 patients who presented to the study sites was reviewed. The details of the background characteristics of the patients are described elsewhere [ 16 ]. At the time of inpatient care, 315 (50.9%) of the patients were reported to be HIV negative, 142 (22.9%) were HIV positive and 162 (26.2%) had an unknown HIV status.…”

Section: Resultsmentioning

confidence: 99%

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Management of post abortion complications in Botswana -The need for a standardized approach

Melese

Habte²,

Tsima

et al. 2018

PLoS ONE

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BackgroundPost abortion complications are the third leading cause of maternal death after hemorrhage and hypertension in Botswana where abortion is not legalized. This study aimed at assessing the management of post abortion complications in Botswana.MethodsA retrospective study was conducted at four hospitals in Botswana in 2014. Socio-demographic, patient management and outcomes data were extracted from patients’ medical records. Descriptive statistics and chi-square test were used to analyze and present the data.ResultA total of 619 patients’ medical records were reviewed. The duration of hospital stay prior to uterine evacuation ranged from less than an hour to 480 hours. All the patients received either prophylactic or therapeutic antibiotics. Use of parenteral antibiotics was significantly associated with severity of abortion, second trimester abortion, use of blood products and the interval between management’s decision and uterine evacuation. Uterine evacuation for retained products of conception was achieved by metallic curettage among 516 (83.4%) patients and by vacuum aspiration in 18 (2.9%). At all the study sites, Misoprostol or Oxytocin were used concurrently with surgical evacuation of the uterus. None use of analgesics or anesthetics in the four hospitals ranged between 12.4% to 28.8%.ConclusionThere is evidence of delayed patient care and prolonged hospital stay. Metallic curette was the primary method used for uterine evacuation across all the facilities. Pain management and antibiotics use was not standardized. A protocol has to be developed with the aim of standardizing post abortion care.

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Section: Discussionsupporting

confidence: 54%

Section: Resultsmentioning

confidence: 99%

Management of post abortion complications in Botswana -The need for a standardized approach

Melese

Habte²,

Tsima

et al. 2018

PLoS ONE

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Section: Introductionmentioning

confidence: 99%

“…Policy and legal contexts shape the quality of services provided; these are international, regional and country-specific in content or implementation [ 8 , 9 ]. Abortion remains an illegal or highly restricted and emotive issue in most countries globally [ 9 , 10 ]. Limited access to safe abortion, both formally and informally, increases women’s recourse to unsafe termination procedures, and negative community and facility-based attitudes limit the effectiveness of interventions to provide quality PAC services.…”

Section: Introductionmentioning

confidence: 99%

Policy, law and post-abortion care services in Kenya

et al. 2018

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BackgroundUnsafe abortion is still a leading cause of maternal death in most Sub-Saharan African countries. Post-abortion care (PAC) aims to minimize morbidity and mortality following unsafe abortion, addressing incomplete abortion by treating complications, and reducing possible future unwanted pregnancies by providing contraceptive advice. In this article, we draw on data from PAC service providers and patients in Kenya to illustrate how the quality of PAC in healthcare facilities is impacted by law and government policy.MethodsA cross-sectional design was used for this study, with in-depth interviews conducted to collect qualitative data from PAC service providers and seekers in healthcare facilities. Data were analyzed both deductively and inductively, with diverse sub-themes related to specific components of PAC quality.ResultsThe provision of quality PAC in healthcare facilities in Kenya is still low, with access hindered by restrictions on abortion. Negative attitudes towards abortion result in the continued undirected self-administration of abortifacients. Intermittent service interruptions through industrial strikes and inequitable access to care also drive unsafe terminations. Poor PAC service availability and lack of capacity to manage complications in primary care facilities result in multiple referrals and delays in care following abortion, leading to further complications. Inefficient infection control exposes patients and caregivers to unrelated infections within facilities, and the adequate provision of contraception is a continued challenge.DiscussionLegal, policy and cultural restrictions to access PAC increase the level of complications. In Kenya, there is limited policy focus on PAC, especially at primary care level, and no guidelines for health providers to provide legal, safe abortion. Discrimination at the point of care discourages women from presenting for care, and discourages providers from freely offering post-abortion contraceptive guidance and services. Poor communication between facilities and communities continues to result in delayed care and access-related discrimination.ConclusionGreater emphasis should be placed on the prevention of unsafe abortion and improved access to post-abortion care services in healthcare facilities. There is a definite need for service guidelines for this to occur.

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“…Infection is a serious potential consequence of surgery to complete a spontaneous abortion, in particular in low-and middle-income countries. 4 Pelvic infection can result in serious illness and death, 5 as well as long-term consequences from pelvic scarring, including increased rates of ectopic pregnancy and infertility. 6 Antibiotic prophylaxis before some operations has been shown to reduce the risk of postoperative infections.…”

mentioning

confidence: 99%

A Randomized Trial of Prophylactic Antibiotics for Miscarriage Surgery

Lissauer¹,

Wilson²,

Hewitt³

et al. 2019

Obstetric Anesthesia Digest

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BACKGROUND Surgical intervention is needed in some cases of spontaneous abortion to remove retained products of conception. Antibiotic prophylaxis may reduce the risk of pelvic infection, which is an important complication of this surgery, particularly in low-resource countries. METHODS We conducted a double-blind, placebo-controlled, randomized trial investigating whether antibiotic prophylaxis before surgery to complete a spontaneous abortion would reduce pelvic infection among women and adolescents in low-resource countries. We randomly assigned patients to a single preoperative dose of 400 mg of oral doxycycline and 400 mg of oral metronidazole or identical placebos. The primary outcome was pelvic infection within 14 days after surgery. Pelvic infection was defined by the presence of two or more of four clinical features (purulent vaginal discharge, pyrexia, uterine tenderness, and leukocytosis) or by the presence of one of these features and the clinically identified need to administer antibiotics. The definition of pelvic infection was changed before the unblinding of the data; the original strict definition was two or more of the clinical features, without reference to the administration of antibiotics. RESULTS We enrolled 3412 patients in Malawi, Pakistan, Tanzania, and Uganda. A total of 1705 patients were assigned to receive antibiotics and 1707 to receive placebo. The risk of pelvic infection was 4.1% (68 of 1676 pregnancies) in the antibiotics group and 5.3% (90 of 1684 pregnancies) in the placebo group (risk ratio, 0.77; 95% confidence interval [CI], 0.56 to 1.04; P = 0.09). Pelvic infection according to original strict criteria was diagnosed in 1.5% (26 of 1700 pregnancies) and 2.6% (44 of 1704 pregnancies), respectively (risk ratio, 0.60; 95% CI, 0.37 to 0.96). There were no significant between-group differences in adverse events. CONCLUSIONS Antibiotic prophylaxis before miscarriage surgery did not result in a significantly lower risk of pelvic infection, as defined by pragmatic broad criteria, than placebo.

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High Levels of Post-Abortion Complication in a Setting Where Abortion Service Is Not Legalized

Cited by 36 publications

References 25 publications

Management of post abortion complications in Botswana -The need for a standardized approach

Management of post abortion complications in Botswana -The need for a standardized approach

Policy, law and post-abortion care services in Kenya

A Randomized Trial of Prophylactic Antibiotics for Miscarriage Surgery

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