尼日利亚一家三级医院在新冠疫情时代前六年的不安全堕胎负担：一项回顾性分析研究

The Burden of Unsafe Abortion Six Years before the COVID-19 Era in a Nigerian Tertiary Hospital: An Analytical Retrospective Study.

作者信息

Obadina O D, Ubom A E, Adewole A A, Oriji P C, Musa A, Fiebai P O, Onile T G, Nyeche S, Gbejegbe E, Sule S O, Adebawojo T O, Ikimalo J I

机构信息

Department of Obstetrics and Gynaecology, Federal Medical Centre, Lokoja, Kogi State, Nigeria.

Department of Obstetrics, Gynaecology, and Perinatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.

出版信息

West Afr J Med. 2023 Jan 30;40(1):90-96.

PMID:36716707

Abstract

BACKGROUND

Unsafe abortion remains a leading cause of maternal mortality and morbidity, especially in developing countries with restrictive abortion laws. Disease containment measures during the COVID-19 pandemic have reduced access to contraception and safe abortion care, potentially increasing rates of unintended pregnancies and unsafe abortion.

OBJECTIVE

To evaluate the morbidity and mortality burden of unsafe abortion before the COVID-19 pandemic.

METHODS

A six-year analytical retrospective study of unsafe abortion at the Federal Medical Centre, Lokoja, Nigeria. All case records of unsafe abortion managed within the study period were retrieved, and relevant data extracted using a purpose-designed proforma. Data obtained was analysed using the IBM SPSS Statistics for Windows, version 25 (IBM Corp., Armonk, N.Y., USA). Associations between categorical independent and outcome variables were assessed using the Chi square test at 95% confidence level. A p-value of <0.05 was considered statistically significant.

RESULTS

The prevalence of unsafe abortion was 8.6 per 1,000 deliveries. More than one-half (37, 52.9%) were medical abortions using misoprostol tablets. The mean age of the women was 23.15+ 3.96 years, and most of them were single (49, 70%), with primary/ secondary education (42, 60%), and of low socioeconomic status (67, 95.7%). Nearly one-half (33, 47.1%) had either never used any modern contraceptive (9, 12.9%) or only used emergency contraception (24, 34.3%). The predominant complications of unsafe abortion included retained product of conception (69, 98.6%), haemorrhagic shock (22,31.4%), and sepsis (19, 27.1%). There were two maternal deaths, giving a case fatality rate of 2.9%.

CONCLUSION

Unsafe abortion remains a significant cause of maternal mortality and morbidity in our setting. Improving access to effective modern contraceptives and liberalizing our abortion laws may reduce maternal morbidity and mortality from unsafe abortion.

摘要

背景

不安全堕胎仍然是孕产妇死亡和发病的主要原因，尤其是在堕胎法律严格的发展中国家。2019年冠状病毒病（COVID-19）大流行期间的疾病防控措施减少了避孕和安全堕胎护理的可及性，可能会增加意外怀孕和不安全堕胎的发生率。

目的

评估COVID-19大流行之前不安全堕胎的发病和死亡负担。

方法

在尼日利亚洛科贾联邦医疗中心进行了一项为期六年的不安全堕胎分析性回顾性研究。检索了研究期间处理的所有不安全堕胎病例记录，并使用专门设计的表格提取相关数据。使用IBM SPSS Statistics for Windows 25版（美国纽约州阿蒙克市IBM公司）对获得的数据进行分析。分类自变量和结果变量之间的关联采用卡方检验，置信水平为95%。p值<0.05被认为具有统计学意义。

结果

不安全堕胎的发生率为每1000例分娩8.6例。超过一半（37例，52.9%）为使用米索前列醇片的药物流产。这些女性的平均年龄为23.15±3.96岁，大多数为单身（49例，70%），接受过小学/中学教育（42例，60%），社会经济地位较低（67例，95.7%）。近一半（33例，47.1%）从未使用过任何现代避孕方法（9例，12.9%）或仅使用过紧急避孕方法（24例，34.3%）。不安全堕胎的主要并发症包括妊娠物残留（69例，98.6%）、失血性休克（22例，31.4%）和败血症（19例，27.1%）。有2例孕产妇死亡，病死率为2.9%。