Department of Obstetrics, Gynaecology and Perinatology, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria.
Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.
West Afr J Med. 2020 Nov;37(6):645-649.
Abortion-related sepsis contributes significantly to reproductive morbidity and preventable mortality in Nigeria. Effective strategies to combat the associated Severe Maternal Outcomes (SMO) requires reliable statistics and an understanding of the immediate contributors.
A retrospective review of women managed for abortion-related sepsis between September, 2006 and August, 2015 at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria. The socio-demographic characteristics, pattern of presentation, reasons for termination of pregnancy and clinical outcomes were analysed. Life-threatening complication rate, mortality index and maternal mortality ratio were determined using the WHO "Near-Miss" concept.
Overall, 128 women were managed for abortion-related sepsis, with 11,565 live births within the decade. Eighty (79.6%) of the 88 women with induced abortions were not on contraception, though pregnancy was not desired. Interference with education, paternity dispute and short inter-pregnancy interval were the commonest reasons for pregnancy termination. Near-misses were recorded in 67.5% of the women, especially anaemia requiring at least 4units of blood and laparotomy for non-caesarean indications. The mortality-index and case fatality rate were 13.9% and 9.4% respectively, predominantly due to multiple organ dysfunction from overwhelming sepsis.
The life-threatening complication rate and mortality index associated with abortion-related sepsis at the OAUTHC remain bothersome, with a 1:7.5 chance of mortality once diagnosed. The maternal near-misses identified in this study would serve as alert signals to Physicians on the risk of maternal death in these women. Strategies should be implemented to facilitate access to contraception, standardised abortion-related services and hospital-based interventions to care for maternal near-misses.
在尼日利亚，与堕胎相关的败血症是导致生殖系统发病率和可预防死亡率的主要原因。为了有效应对相关的严重产妇结局（SMO），需要可靠的统计数据和对直接原因的理解。
对 2006 年 9 月至 2015 年 8 月在尼日利亚伊费奥巴费米·阿沃洛沃大学教学医院（OAUTHC）接受与堕胎相关的败血症治疗的妇女进行回顾性分析。分析了社会人口统计学特征、表现模式、终止妊娠的原因和临床结局。使用世界卫生组织（WHO）的“接近死亡”概念确定危及生命的并发症发生率、死亡率指数和孕产妇死亡率。
总体而言，有 128 名妇女因与堕胎相关的败血症接受治疗，在这十年中，有 11565 名活产。88 名因人工流产的妇女中，有 80 名（79.6%）没有避孕，尽管她们不希望怀孕。干扰教育、亲子纠纷和妊娠间隔短是终止妊娠的最常见原因。近 67.5%的妇女出现接近死亡的情况，特别是因贫血需要至少输注 4 单位的血液和因非剖宫产原因进行剖腹手术。死亡率指数和病死率分别为 13.9%和 9.4%，主要是由于败血症导致多器官功能障碍。
OAUTHC 与堕胎相关的败血症相关的危及生命的并发症发生率和死亡率仍然令人担忧，一旦确诊，死亡率为 1:7.5。本研究中确定的孕产妇接近死亡病例将作为医生在这些妇女中发生孕产妇死亡风险的警报信号。应实施策略，以方便获得避孕措施、标准化的堕胎相关服务和基于医院的干预措施，以照顾孕产妇接近死亡病例。
