How risky are second trimester clandestine abortions in Cameroon: a retrospective descriptive study

Abstract

BackgroundComplications of clandestine abortions increase with gestational age. The aim of this study was to identify complications of second trimester clandestine abortions (STA) and those of first trimester clandestine abortions (FTA).MethodsThis retrospective descriptive study was conducted between March 1st and August 31st, 2012 in the University Teaching Hospital and the Central Hospital, Yaoundé (Cameroon). The files of women with clandestine abortions carried out outside our units, but received in our settings for some complications were reviewed. Variables studied were maternal age, parity, marital status, gestational age at the time of abortion, the abortion provider and the method used, the duration of antibiotic coverage, the time interval between abortion and consultation, the complications presented and the duration of hospital stay. Data of 20 women with STA (≥13 weeks 1 day) and those of 74 women with FTA (≤13 complete weeks) were analyzed and compared. The t-test was used to compare continuous variables. P value <0.05 was considered statistically significant.ResultsWomen with STA had high parities (P = 0.0011). STAs were mostly performed by nurses and were usually done by dilatation and curettage or dilatation and evacuation, manual vacuum aspiration, intramuscular injection of an unspecified medication, transcervical foreign body insertion, amniotomy and misoprostol. STA complications were severe anemia, hypovolemic shock, uterine perforation and maternal death.ConclusionsClandestine abortions, especially second trimester abortions, are associated with risks of maternal morbidity and mortality especially when done by nurses. Therefore, women should seek for help directly from trained health personnel (Gynecologists & Obstetricians). Moreover, nurses should be trained in uterine evacuation procedures. They should also refer women who want to carry out STA to Gynecologists and Obstetricians. Finally, to reduce the prevalence of abortion in general, the government should make contraception available to all women, as well as use public media to sensitize women on the dangers of abortion and on the need to use family planning services.

The magnitude and severity of abortion-related morbidity in settings with limited access to abortion services: a systematic review and meta-regression

“…Only one study reported case fatality by abortion method, with only two deaths reported among women where the method of abortion was ‘not known’. 16 Six studies provided estimates of case fatality by gestational age, 19 20 22–25 and in all studies the case fatality was higher at later gestation (online Supplementary table 3 ).…”

Prospective Comparative Study of Oral Versus Vaginal Misoprostol for Second-Trimester Termination of Pregnancy

“…Unsupervised and unsafe abortions continue to be a major cause of maternal morbidity worldwide [2]. In our country, the liberal MTP Act has unfortunately been misused for second-trimester termination of pregnancy following sex determination and has been intricately (and wrongly) related to the PC-PNDT Act.…”

Eliminating the high abortion related complications and deaths in Cameroon: the restrictive legal atmosphere on abortions is no acceptable excuse

“…Under the present restrictive law, it is reasonable to suspect that most of these could be done under unsafe conditions. Reported methods used to induce these unsafe abortions range from transcervical foreign bodies, injections, unspecified medications and diverse plants [ 10 , 11 ]. Women who survive could suffer from infections, uterine and bowel perforations, infertility, sepsis, conditions generally costly to patients and the health system.…”