Siraneh Yibeltal, Workneh Ahadu
Department of Health Policy and Management, Faculty of Public Health, Institute of Health, Jimma University, Ethiopia.
Department of Obstetric and Gynecology, Faculty of Medical Sciences, Institute of Health, Jimma University, Ethiopia.
J Pregnancy. 2019 Jul 7;2019:4513827. doi: 10.1155/2019/4513827. eCollection 2019.
Although the vast majority of abortions are performed in the first trimester, still 10-15% of terminations of pregnancies have taken place in the second trimester globally. As compared to first trimester, second trimester abortions disproportionately contribute to maternal morbidity and mortality especially in low-income countries where access to safe second trimester abortion is limited. The objective of this study was to identify factors affecting and outcome of induced safe second trimester medical abortion in Jimma University medical center, Southwest Ethiopia.
Institution based cross-sectional study design was used to conduct a study among women who seek safe second trimester medical abortion services and admitted at gynecology ward. All (201) eligible study subjects included were those who came for safe medical abortion service during data collection period. Data collected using pretested structured questionnaire through exit-interviewing and some clinical data abstracted from their chart. The data was entered into EpData version 3.1 then exported to SPSS version 21.0 for analysis. Variables with P-value less than 0.25 in bivariate analysis were entered into the final predictive model. Multivariable logistic regression was used to identify determinants with 95% CI and P-value < 0.05. Hosmer and Lemeshow test were used to check model fitness at P-value of 0.05. Ethical clearance was obtained and confidentiality kept using codes and patient's chart number.
In this study the response rate was 98.1%. Out of 201 women who participated in the study and were addmitted for safe second trimester medical abortion, 154 (76.6%) of them had complete abortion without any complication while the remaining 47 (23.4%) had incomplete abortion with one or more complication. Previous experience of abortion [AOR= 6.00, 95% CI= (3.77, 8.88)], gestational age [AOR=0.90, 95% CI= (0.07, 0.99)], parity [AOR=2.38, 95% CI= (1.04, 3.69)], cervical status [AOR=8.00, 95% CI= (5.72, 10.02)], overall waiting time for more than two weeks [AOR=0.53, 95% CI= (0.50, 0.96)], overall waiting time for two weeks [AOR=0.05, 95% CI= (0.01, 0.45)], and moderate anemia -(Hgb:7-10g/dl)-[AOR=0.07,95% CI= (0.01, 0.16)] were independent predictors for outcome of safe second trimester medical abortion.
This finding implied that proportion of complete abortion without any complication overweighs incomplete abortions with one or more complication through induced safe second trimester medical abortion method. The outcome is strongly determined by gestational age, cervical status, previous experience of abortion, parity, moderate anemia, and overall waiting time. Induced second trimester medical abortion is already known as an effective and safe method. However, much should be done to reduce proportion of incomplete abortions by minimizing overall waiting time through intervening at low gestational age. Therefore, it is recommended that safe second trimester medical abortion services should be continued under a certain legal circumstances so as to reduce maternal morbidity and mortality.
尽管绝大多数堕胎手术在孕早期进行，但全球仍有10%-15%的妊娠终止发生在孕中期。与孕早期相比，孕中期堕胎对孕产妇发病率和死亡率的影响尤其大，特别是在低收入国家，那里获得安全的孕中期堕胎服务的机会有限。本研究的目的是确定影响埃塞俄比亚西南部吉马大学医学中心安全的孕中期人工流产的因素及其结果。
采用基于机构的横断面研究设计，对寻求安全的孕中期人工流产服务并入住妇科病房的妇女进行研究。所有（201名）符合条件的研究对象均为在数据收集期间前来寻求安全人工流产服务的妇女。通过出院访谈使用预先测试的结构化问卷收集数据，并从她们的病历中提取一些临床数据。数据录入EpData 3.1版本，然后导出到SPSS 21.0版本进行分析。在双变量分析中P值小于0.25的变量被纳入最终预测模型。使用多变量逻辑回归确定具有95%置信区间和P值<0.05的决定因素。使用Hosmer和Lemeshow检验在P值为0.05时检查模型拟合度。获得了伦理批准，并使用代码和患者病历号保持保密。
在本研究中，应答率为98.1%。在参与研究并因安全的孕中期人工流产而入院的201名妇女中，154名（76.6%）完全流产且无任何并发症，其余47名（23.4%）流产不全并有一种或多种并发症。既往流产经历[AOR=6.00，95%置信区间=（3.77，8.88）]、孕周[AOR=0.90，95%置信区间=（0.07，0.99）]、产次[AOR=2.38，95%置信区间=（1.04，3.69）]、宫颈状况[AOR=8.00，95%置信区间=（5.72，10.02）]、总体等待时间超过两周[AOR=0.53，95%置信区间=（0.50，0.96）]、总体等待时间两周[AOR=0.05，95%置信区间=（0.01，0.45）]以及中度贫血（血红蛋白：7-10g/dl）[AOR=0.07，95%置信区间=（0.01，0.16）]是安全的孕中期人工流产结果的独立预测因素。
这一发现表明，通过安全的孕中期人工流产方法，无任何并发症的完全流产比例超过有一项或多项并发症的流产不全比例。结果强烈地由孕周、宫颈状况、既往流产经历、产次、中度贫血和总体等待时间决定。孕中期人工流产已被认为是一种有效且安全的方法。然而，应通过在低孕周时进行干预以尽量减少总体等待时间来降低流产不全的比例。因此，建议在一定法律情况下继续提供安全的孕中期人工流产服务，以降低孕产妇发病率和死亡率。
