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20 Post-Induced Abortion Morbidity and Mortality In Vol. 12 No. 1 December, 2010 Post-induced abortion morbidity and mortality in Oleh, Nigeria POST-INDUCED ABORTION MORBIDITY AND MORTALITY IN OLEH, NIGERIA *V.O. Awusi, **V. Okeleke *Department of Family Medicine, Faculty of Medical Sciences, Delta State University, Abraka, Delta State, Nigeria **Central Hospital, Oleh, Isoko South Local Government Area of Delta State, Nigeria. Correspondence address: Dr V.O. Awusi Department of Family Medicine Faculty of Medical Sciences, Delta State University, Abraka, Delta State, Nigeria Email: ABSTRACT death (n = 8) was generalised The aim of this retrospective study septicaemia (37.5%). was to determine the maternal Policy makers and health managers morbidity and mortality among should formulate initiatives to prevent 87patient treated at the Central unwanted pregnancy including health Hospital, Oleh, Delta State, Nigeria, for education/contraceptive utilization and complications of induced abortion from provision of safe abortion services. January 1st 2004 to December 31st 2008. Keywords: abortion, induced, The total number of maternal maternal, morbidity, mortality, law. admissions and deaths, over the period, were, respectively, 3,680 and INTRODUCTION 34(8 from induced abortion). Induced Induced abortion as a means of abortion accounted for 2.4% and terminating pregnancy for medical, 23.5%, respectively, of the total social and eugenic reasons is maternal morbidity (admissions) and practised in many societies1. In mortality. The mean age of the Nigeria, Clinicians are often faced by patients was 20.4±5.6years (range of patients requiring immediate and 15 –36years). Majority were, in age sympathetic help in procuring induced group 15 – 19years (71.2%), abortion because the pregnancy was students/young school leavers “unwanted” at the time. Inspite of this, (85.1%), unmarried (82.8%), abortion law in Nigeria is still unemployed (89.7%) and had had restrictive2 , hence abortions are second trimester abortion (64.4%). It is clandestinely and illegally undertaken significant that of those who had everyday by those least qualified to do second trimester abortion, 66.1% were so3,4 and in substandard medical teenagers. Most (94.3%) of the environment4 resulting in unsafe patients presented with multiple abortion which has been reported5 to complications which included genital cause about 20,000 deaths a year in sepsis (94.3%), retained products of Nigeria. Besides the mortality conception (90.8%), anaemia (17.2%), associated with their practice5, the pelvic infection with peritonitis (17.2%) immediate and long-term morbidity is and abscess formation (15%), uterine enormous and accounts for a (3.5%) and intestinal (2.3%) significant component of a hospital’s perforations. The commonest cause of workload6,7. 20 Vol. 12 No. 1 December, 2010 Post-induced abortion morbidity and mortality in Oleh, Nigeria The study, therefore, was During the same period, there were conducted to highlight the continuing a total of 34 maternal deaths in the association of clandestine induced hospital. Induced abortion accounted abortion with maternal morbidity and for 23.5% of all the maternal deaths mortality in our environment. This may and 2.4% of the total maternal with facilitate the development of admissions. The contribution of policies to correct this scenario. induced abortion to both the total maternal deaths and admissions is MATERIALS AND METHODS significant (P < 0.05). This was a retrospective study The mean age of the patients was carried out in Central Hospital, Oleh, 20.4±5.6years (15–36years). Majority Isoko South Local Government Area were, secondary school students/ (L.G.A.) of Delta State, Nigeria, which leavers (85.1%), unmarried (82.8%) serves as the district referral centre for and unemployed (89.7%). Table 1 the whole of Isoko L.G.A. (North and shows the age distribution, educational South) and its neighbouring levels of the patients and gestational communities. The case-file of 87 age at termination. Most were in the patients who were admitted and age group 15 – 19years (71.2%) and treated for complications of induced had had 2nd trimester abortion (64.4%) st abortion, between January 1 2004 out of which those in the age group of st and December 31 2008, were 15 – 19years (teenagers) constituted retrieved from the medical records 42.5%. Only 35.6% of the patients had library and reviewed. 1st trimester abortion. Table 2 shows Information retrieved from the case the various complications the patients note included relevant socio- presented with. Majority (94.3%) had demographic data and clinical multiple morbidities. Genital sepsis information which included the method was the most frequent complication used in procuring the abortion, (94.3%) found in all except five gestational age the termination patients with incomplete abortion. occurred, practitioners’ status and the Others were retained products of associated morbidities. conception (90.8%), peritonitis (17.2%), A data base was generated with anaemia (17.2%), pelvic abscess the information and analysed (15.0%), septicaemia (11.5), cervical manually. Analysis was done to laceration (5.8%), uterine (3.5%) and compare mean values and intestinal (2.3%) perforations. Eight frequencies/percentages, and the died (9.2%). student’s t-test for association between The major complications associated the variables where appropriate. with maternal deaths were generalised septicaemia (37.5%), jaundice (25%), RESULTS anaemia (12.5%), peritonitis (12.5%) During the period under review, and uterine perforation (12.5%) as there were a total of 3,680 maternal shown in Table 3. admissions. Out of the 573 cases of In addition to the definitive abortion during the study period, 87 treatment given, all the patients cases were induced making the received appropriate antibiotic therapy; prevalence of induced abortion 15.2%. 38 (43.7%) received blood transfusion, There were 8 deaths recorded among ranging from 1 – 6 units (average 2) of the cases of induced abortion giving a whole blood. fatality rate of 23.5% for induced abortion 21 Vol. 12 No. 1 December, 2010 Post-induced abortion morbidity and mortality in Oleh, Nigeria Table 1: Age distribution, educational Table 3: Complications associated with level and gestational age at maternal death termination No. of Causes patients (%) Variable Frequency Percentage Generalized Age groups septicaemia 3 (37.5) 15 – 19 62 71.2 Sepsis with jaundice 2 (25.0) 20 – 24 13 15.0 Sepsis with anaemia 1 (12.5) 25 – 29 7 8.0 Peritonitis 1 (12.5) 30 – 34 2 2.3 Uterine perforation > 34 3 3.5 with peritonitis 1 (12.5) Total 87 100 Total 8 (100) Level of education Discussion None 0 0.0 This study report that induced Primary 5 5.7 abortion contributed significantly to the Secondary 74 85.1 maternal morbidity (2.4%) and Tertiary 8 9.2 mortality (23.5%) of the women who Trimester at attended Central Hospital, Oleh, Delta Termination of State of Nigeria, from January 1st 2004 pregnancy to December 31st 2008. The results of First this study is similar to published data1 trimester 31 35.6 that induced abortion with its attendant Second sequelae is increasing in many trimester 56 64.4 developing countries, as also in other studies which reported maternal morbidity of 2.3% (Eku, Nigeria)8, 1.3% Table 2: Complications associated with (Nnewi, Nigeria)3, 0.4% (Nakuru, induced abortion Kenya)9 and mortality rates of 22.6%8 , 21.1%3 and 25%9 following induced No. of abortion. The above post-induced Complications patients (%) abortion maternal mortality rates, from developing countries, are far higher Genital sepsis 82 (94.3) than the rates reported from developed Retained products of countries such as United Kingdom – conception 79 (90.8) 4.7%10 and United States of America – 11 Peritonitis 15 (17.2) less than 1% . This may be due to the latter’s better health-care Anaemia 15 (17.2) services/health-seeking behaviour and Pelvic abscess 13 (15.0) provision of safe/legal abortion Septicaemia 10 (11.5) services. Cervical laceration 5 (5.8) The restrictive abortion law in most Uterine perforation 3 (3.5) developing countries is a contributory factor to these post-abortion negative Intestinal perforation 2 (2.3) maternal health indices, as the law has Death 8 (9.2) prevented the institutionalization of safe abortion practices12, and has 22 Vol. 12 No. 1 December, 2010 Post-induced abortion morbidity and mortality in Oleh, Nigeria continued to pave way for thriving unmarried women who are backdoor and lay abortionists2,6 who students/recent school leavers with lack the necessary skills and operates unwanted pregnancy and induced in an environment lacking the abortion provides direction for minimum medical standards4. strategies for the prevention of the As in other studies13,14 , majority of complications of induced abortion, viz : our patients who had undergone health education including positive induced abortion were teenagers and health-seeking behaviour and presented themselves for abortion contraceptive utilization should be when the pregnancy was advanced optimised among all women (and and, therefore requiring relatively more men), but in particular among complicated termination procedure adolescents who have been reported which only a specialist may handle. to be at risk of unwanted But, either because of their health- pregnancy4,13,14. However, low seeking behaviour, socio-economic, contraceptive uptake among cultural disapproval of pre-marital sex unmarried girls and separated couples and/or legal restriction reasons, these has been reported in Nigeria4 and women hide their pregnancy and other developing countries13. This has resort to unskilled providers, use been attributed to their attitude of dangerous methods and most times, wanting to keep sexual activity secret; delay in seeking help after therefore most sexually active women complication(s) develop; and only seek do not use contraceptive, with the help when they become seriously ill 3,7. attendant risk of unwanted pregnancy, This explains the high incidence of consequent induced abortion and its serious complications such as health consequences as shown in this anaemia and infectious morbidities – study and others5,7,9 .
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