Magnitude of Severe Acute Maternal Morbidity and Associated Factors Related to Abortion: A Cross-Sectional Study in Hawassa University Comprehensive Specialized Hospital, Ethiopia, 2019

Abstract

Background. Abortion-related mortality is decreasing, but the complication is still causing a significant morbidity to mothers especially in developing countries. Recently, suitable criteria to assess maternal near miss for sub-Saharan countries were adapted in harmony with the previous World Health Organization near-miss criteria. The aim of this study was to assess the magnitude of severe acute maternal morbidity and associated factors related to abortion in Hawassa University Comprehensive Specialized Hospital, Ethiopia. Method. An institution-based cross-sectional study was conducted among 337 women who sought abortion services at Hawassa University Comprehensive Specialized Hospital from January 1 to October 30, 2019. The participants were selected conveniently. Data was collected by using prospective morbidity methodology with pretested anonymous structured English questionnaire. The collected data were then entered into SPSS version 20 for analysis. Variables with p value ≤ 0.2 in the bivariate analysis, not collinear, were entered to multivariable regression. The strength of association is presented by odds ratio and 95% confidence interval. p value less than 0.05 was used as a cut-off point to determine statistically significant association. Results. The magnitude of severe acute maternal morbidity and maternal near miss is found to be 35.6 and 17.7%, respectively. Factors significantly associated with severe acute maternal morbidity were as follows: women uneducated (AOR: 3.02; 95% CI 1.24-7.33), second-trimester pregnancy (1.89-9.14), and delayed presentation (AOR: 4.32, 95% CI 1.76-10.59). Conclusion. Severe acute maternal morbidity and maternal near miss related to abortion are high despite the availability of safe termination. Near-miss cases could be better traced by using reasonably adapted World Health Organization near-miss criteria for sub-Saharan countries. Lack of education, increased gestational age, and delayed presentation had increased severe acute maternal morbidity associated with abortion which may need further education on health care seeking culture of the community.

Management outcome of incomplete abortion in Injibara General Hospital, Northwest Ethiopia: a cross-sectional study

“…Second-trimester abortions disproportionately contribute to the increased medical cost, maternal morbidity, and mortality compared to the rst trimester [24,29] Women who sought care after 24 hours of the onset of symptoms of incomplete abortion were 3.97 times more likely to develop unfavorable management outcomes of incomplete abortion than those who seek care within 24 hours. It agrees with studies done in Ethiopia [23,27]. The delay between symptom onset and diagnosis of pregnancy loss or between diagnosis of pregnancy loss and expulsion of the pregnancy increases the risk of developing complications.…”

“…The data was collected using structured data extraction tools prepared in the English language, which were adapted from relevant works of literature related to the topic [23,27]. The checklist consisted of: maternal socio-demographic characteristics, past and current obstetric history, management method, and outcome of incomplete abortion management.…”

“…Incomplete abortion is de ned by the clinical presentation of an open cervical os and bleeding, whereby all products of conception have not been expelled from the uterus [23].…”

“…Around 9% of abortion-related hospital admissions have a near-miss event and approximately 1.5% end in death [22,23]. The leading cause of maternal death associated with spontaneous abortion was an infection, followed by hemorrhage, embolism, anesthesia complications, and other causes like disseminated intravascular coagulation [24].…”

“…Most of the time unfavorable management outcomes of incomplete abortion are associated with the gestational age of the pregnancy, the timing of seeking care after the onset of symptoms, methods of management, and pre-existing maternal infections [23,24,[27][28][29]. In general, abortion-related consequences have an impact on the lives of individuals, families, society, and the country as a whole and cost various budgets, and long-term disabilities such as lengthy hospitalization and sterility [27,30,31].…”