Analysis of induced abortion-related complications in women admitted to referral health facilities in Kinshasa, Democratic Republic of the Congo

Abstract

BackgroundDue to a lack of relevant data on induced abortions in the Democratic Republic of the Congo (DRC), as well as the persistence of maternal deaths in the country, this study aims to analyze the extent and characteristics of induced abortion-related complications in women who were admitted to referral health facilities in Kinshasa, including the duration of hospitalization, the mortality rate due to induced abortion complications and their characteristics, and the deaths that occurred after two days of hospitalization.MethodsThis is a cross-sectional study on 843 obstetric and gynecological patients who were admitted as emergency cases to five referral health facilities in Kinshasa during 2014. These facilities were selected as being representative of five types of districts in Kinshasa, according to their cultural, socioeconomic, and infrastructural characteristics. Patient data were collected from patient records and analyzed.ResultsFrom the 843 patients admitted to receive obstetric and gynecological emergency care services in 2014 at the health facilities surveyed, 14.7% (95% CI: 12.4–17.3%) had complications due to induced abortion. These complications were significantly diagnosed in adolescents (p = 0.003) and in single, separated, divorced, or widowed women (p = 0.03). The median duration of hospitalization was nine days, and this period of time was significantly longer for the patients who underwent surgery for pelvic peritonitis due to uterine perforation compared with the patients who underwent Caesarean section/hysterectomy. Furthermore, it was significantly longer for the patients who were treated for other induced-abortion related complications compared with patients treated for spontaneous abortion. The mortality rate related to induced abortions was 5.6% (95% CI: 2.3–11.3%), with an increase in risk of death in the presence of a postabortive pelvic peritonitis-type complication; 42.9% of deaths occurred after two days of hospitalization.ConclusionThe complications of induced abortions are a major public health problem due to their frequency among patients admitted to Kinshasa's referral health facilities, their mortality, and their poor medical management. Therefore, there is a need to understand the reason for its poor medical management in order to provide an adequate intervention program.

Effects of implementing a postabortion care strategy in Kinshasa referral hospitals, Democratic Republic of the Congo

“…However, it is not clear that a majority of patients benefited from implementation of the PAC strategy. The range of duration of hospitalization among women treated for induced-abortion complications in the intervention hospitals is essentially the same as observed in Kinshasa hospitals in 2014 (1–3 days) [ 9 ], and this duration is higher than in many other African countries, which are below 24 h [ 31 , 36 ]. A possible explanation for prolonged duration of hospitalization in Kinshasa hospitals is that patients are detained for lack of payment of hospitalization costs.…”

“…Mortality among these women was 5.6%, and half of these deaths occurred after 2 days of hospitalization. These data suggest that some women with complications of induced abortion may be poorly managed [ 9 ].…”

Discriminação racial e saúde: ações dos profissionais de saúde na assistência à mulher em processo de abortamento provocado

“…Na análise da assistência por profissionais de saúde, a percepção dos sujeitos sobre o aborto provocado e das mulheres enquanto potenciais mães se somam aos sentidos atribuídos ao hospital-maternidade para influenciar negativamente a qualidade do atendimento, levando à objetificação das mulheres em abortamento 45 . De modo geral, o conjunto de profissionais ao serem questionados acerca dos possíveis motivos que levam as mulheres a engravidar e abortar, sem distinção de categoria ocupacional, descreve as usuárias que induziram o aborto, incluindo uma ou mais das seguintes características: negras, precárias condições financeiras, baixa escolaridade, instabilidade do laço conjugal, abandono do parceiro, falta de apoio familiar, irresponsáveis e de sexualidade desenfreada 38,39,44,47,48,51,52 .…”

“…Estas últimas são desqualificadas 24,29 , sendo atribuído um estado de anormalidade psíquica ao praticarem um aborto. Os resultados expressam indícios de que as instituições de saúde e os profissionais desses hospitais abarcam em suas práticas a violência institucional 38,40,41,43,49,53 , sobretudo com práticas desumanizantes de atenção 51,52 e violência simbólica 52 . Ademais, a não priorização do atendimento às mulheres com abortamento é evidente na pouca atenção dada a estas usuárias, e a existência de discriminação racial.…”

Grossesses non planifiées et avortements à Kinshasa (République Démocratique du Congo) : Défis et progrès

“…Toutes les patientes ont été considérées avoir obtenu l'intervention avant la 12 e semaine de gestation, généralement auprès de prestataires non qualifiés. Une seconde étude, menée à Kinshasa en 2014, s'est concentrée sur les femmes admises aux services d'obstétrique d'urgence de cinq grands hôpitaux de référence 64 . Parmi ces femmes, près de 15% souffraient de complications d'un avortement.…”