Mellerup Natja, Sørensen Bjarke L, Kuriigamba Gideon K, Rudnicki Martin
Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark.
Centre for Innovative Medical Technology, University of Southern Denmark, Odense, Denmark.
BMC Womens Health. 2015 Sep 20;15:76. doi: 10.1186/s12905-015-0233-y.
Complications of unsafe abortion are a major contributor to maternal deaths in developing countries. This study aimed to evaluate the clinical assessment for life-threatening complications and the following management in women admitted with complications from abortions at a rural hospital in Uganda.
A partially completed criterion-based audit was conducted comparing actual to optimal care. The audit criteria cover initial clinical assessment of vital signs and management of common severe complications such as sepsis and haemorrhage. Sepsis shall be managed by immediate evacuation of the uterus and antibiotics in relation to and after surgical management. Shock by aggressive rehydration followed by evacuation. In total 238 women admitted between January 2007 and April 2012 were included. Complications were categorized as incomplete, threatened, inevitable, missed or septic abortion and by trimester. Actual management was compared to the audit criteria and presented by descriptive statistics.
Fifty six per cent of the women were in second trimester. Abortion complications were distributed as follows: 53 % incomplete abortions, 28 % threatened abortions, 12 % inevitable abortions, 4 % missed abortions and 3 % septic abortions. Only one of 238 cases met all criteria of optimal clinical assessment and management. Thus, vital signs were measured in 3 %, antibiotic criteria was met in 59 % of the cases, intravenous fluid resuscitation was administered to 35 % of women with hypotension and pain was managed in 87 % of the cases. Sharp curettage was used in 69 % of those surgically evacuated and manual vacuum aspiration in 14 %. In total 3 % of the abortions were categorized as unsafe. Two of eight women with septic abortion had evacuation performed during admission-day, one woman died due to septic abortion and one from severe haemorrhage.
Guidelines were not followed and suboptimal assessment or management was observed in all but one case. This was especially due to missing documentation of vital signs necessary to diagnose life-threatening complications, poor fluid resuscitation at signs of shock, and delayed evacuation of septic abortion.
不安全流产的并发症是发展中国家孕产妇死亡的主要原因。本研究旨在评估乌干达一家农村医院收治的流产并发症妇女危及生命并发症的临床评估及后续管理。
开展了一项部分完成的基于标准的审核，将实际护理与最佳护理进行比较。审核标准涵盖生命体征的初始临床评估以及败血症和出血等常见严重并发症的管理。败血症应通过立即清空子宫并在手术管理期间及之后使用抗生素进行治疗。休克则通过积极补液后再进行清空子宫处理。2007年1月至2012年4月期间收治的238名妇女被纳入研究。并发症分为不全流产、先兆流产、难免流产、稽留流产或感染性流产，并按孕周分类。将实际管理与审核标准进行比较，并通过描述性统计进行呈现。
56%的妇女处于妊娠中期。流产并发症分布如下：53%为不全流产，28%为先兆流产，12%为难免流产，4%为稽留流产，3%为感染性流产。238例病例中只有1例符合最佳临床评估和管理的所有标准。因此，3%的病例测量了生命体征，59%的病例符合抗生素使用标准，35%低血压妇女接受了静脉液体复苏，87%的病例疼痛得到了处理。69%接受手术清空子宫的患者采用了刮宫术，14%采用了人工负压吸引术。总共有3%的流产被归类为不安全。8例感染性流产妇女中有2例在入院当天进行了清空子宫处理，1例妇女死于感染性流产，1例死于严重出血。
除1例病例外，均未遵循指南，观察到评估或管理欠佳。这尤其归因于缺乏诊断危及生命并发症所需生命体征的记录、休克迹象出现时液体复苏不佳以及感染性流产清空子宫延迟。
