Epicentre - Médecins Sans Frontières, 34, avenue Jean Jaurès, 75019, Paris, France.
Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
BMC Pregnancy Childbirth. 2023 Mar 4;23(1):143. doi: 10.1186/s12884-023-05427-6.
Abortion-related complications are one of the five main causes of maternal mortality. However, research about abortion is very limited in fragile and conflict-affected settings. Our study aims to describe the magnitude and severity of abortion-related complications in two referral hospitals supported by Médecins Sans Frontières and located in such settings in northern Nigeria and Central African Republic (CAR).
We used a methodology similar to the World Health Organization (WHO) near-miss approach adapted in the WHO multi-country study on abortion (WHO-MCS-A). We conducted a cross-sectional study in the two hospitals providing comprehensive emergency obstetric care. We used prospective medical records' reviews of women presenting with abortion-related complications between November 2019 and July 2021. We used descriptive analysis and categorized complications into four mutually exclusive categories of increasing severity.
We analyzed data from 520 and 548 women respectively in Nigerian and CAR hospitals. Abortion complications represented 4.2% (Nigerian hospital) and 19.9% (CAR hospital) of all pregnancy-related admissions. The severity of abortion complications was high: 103 (19.8%) and 34 (6.2%) women were classified as having severe maternal outcomes (near-miss cases and deaths), 245 (47.1%) and 244 (44.5%) potentially life-threatening, 39 (7.5%) and 93 (17.0%) moderate, and 133 (25.6%) and 177 (32.3%) mild complications, respectively in Nigerian and CAR hospitals. Severe bleeding/hemorrhage was the main type of complication in both settings (71.9% in the Nigerian hospital, 57.8% in the CAR hospital), followed by infection (18.7% in the Nigerian hospital, 27.0% in the CAR hospital). Among the 146 women (Nigerian hospital) and 231 women (CAR hospital) who did not report severe bleeding or hemorrhage before or during admission, anemia was more frequent in the Nigerian hospital (66.7%) compared to the CAR hospital (37.6%).
Our data suggests high severity of abortion-related complications in these two referral facilities of fragile and conflict-affected settings. Factors that could contribute to this high severity in these contexts include greater delays in accessing post-abortion care, decreased access to contraceptive and safe abortion care that result in increased unsafe abortions; as well as increased food insecurity leading to iron-deficiencies and chronic anaemia. The results highlight the need for better access to safe abortion care, contraception, and high quality postabortion care to prevent and manage complications of abortion in fragile and conflict-affected settings.
与堕胎相关的并发症是导致产妇死亡的五个主要原因之一。然而，在脆弱和受冲突影响的环境中，有关堕胎的研究非常有限。我们的研究旨在描述在北部尼日利亚和中非共和国（CAR）由无国界医生组织支持的两家转诊医院中与堕胎相关的并发症的严重程度和发生率。
我们使用了类似于世界卫生组织（WHO）采用的接近失败方法的方法，该方法在 WHO 多国家堕胎研究（WHO-MCS-A）中进行了调整。我们在这两家提供全面急诊产科护理的医院进行了一项横断面研究。我们使用前瞻性的病历回顾，对 2019 年 11 月至 2021 年 7 月期间因与堕胎相关的并发症而就诊的妇女进行了分析。我们使用描述性分析，并将并发症分为四个相互排斥的严重程度类别。
我们分别分析了来自尼日利亚和 CAR 医院的 520 名和 548 名妇女的数据。堕胎并发症占所有与妊娠相关住院的 4.2%（尼日利亚医院）和 19.9%（CAR 医院）。堕胎并发症的严重程度很高：103 名（19.8%）和 34 名（6.2%）妇女被归类为出现严重产妇结局（接近失败病例和死亡），245 名（47.1%）和 244 名（44.5%）可能危及生命，39 名（7.5%）和 93 名（17.0%）中度，133 名（25.6%）和 177 名（32.3%）轻度并发症，分别在尼日利亚和 CAR 医院。严重出血/出血是这两个环境中的主要并发症类型（尼日利亚医院 71.9%，CAR 医院 57.8%），其次是感染（尼日利亚医院 18.7%，CAR 医院 27.0%）。在 146 名（尼日利亚医院）和 231 名（CAR 医院）在入院前或入院期间未报告严重出血或出血的妇女中，尼日利亚医院贫血更为常见（66.7%），而 CAR 医院为（37.6%）。
我们的数据表明，在这两个脆弱和受冲突影响的环境中的转诊机构中，与堕胎相关的并发症严重程度很高。在这些情况下，导致这种高严重程度的因素可能包括在获得堕胎后护理方面的更大延迟，获得避孕和安全堕胎护理的机会减少，导致不安全堕胎增加；以及粮食不安全导致缺铁和慢性贫血增加。结果强调需要更好地获得安全堕胎护理、避孕和高质量的堕胎后护理，以防止和管理脆弱和受冲突影响环境中的堕胎并发症。
