Patterns of Late Presentation of Septic Abortions at Makurdi, North-Central, Nigeria

Abstract

Background: Unsafe abortion is frequent in our community and invariably; the majority of these cases become septic and present late at the hospital. We decided to study, among other things, the factors responsible for late presentations among these patients with the attendant frequency of complications and the outcome of management of these complications. Method: This was a prospective study that was conducted from January 2010 to June 2014 in the Gynae Unit of the Benue State University Teaching Hospital, Makurdi. All the patients who presented with complications of unsafe abortion were included in the study. Results: In the three and half years period of the study, the total Gynae admissions were 652. There were 82 cases of induced abortions which give an incidence of 12.5%. Age range of the patients was 17-48 years, with a mean of 29 years. More than half of the patients presented 2 to 3 weeks after the initial procedure 51 (62.2%), while only 10 (12.2%) presented within 1 week. The commonest reason for late presentation was the desire to maintain secrecy 54 (65.9%) though majority gave more than one reason 68 (82.9%). Majority of the patients were single, of low parity, belong to the lower socioeconomic group and were not using any form of contraception. Thirty-seven patients (45.1%) presented with severe genital sepsis while 29 patients (35.4%) presented with heavy vaginal bleeding due to incomplete abortion. Five patients (6.1%) presented in shock due to excessive bleeding while 4 (4.9%) patients had uterine perforation and intra-peritoneal haemorrhage. Two patients (2.4%) had gut injury following uterine perforation. Two patients (2.4%) developed uterine gangrene. There were also three cases (3.7%) of peritonitis due to pelvic abscess. The maternal motility in our study was 3 out of 82 cases (3.7%). Conclusion: Induced septic abortions are a significant cause of maternal morbidity and mortality. Improving accessibility to hospital care, increasing literacy rate in our female population and effective family planning, women empowerment and utilizing several resources to develop awareness of the hazards of induced abortions in the community will lead to a reduction in its incidence.