Trends in misoprostol use and abortion complications: A cross-sectional study from nine referral hospitals in Nigeria

Abstract

ObjectiveThe study aimed to assess the use of misoprostol and complications associated with abortions in referral hospitals in Nigeria, a country with restrictive abortion laws.MethodsA cross-sectional study at nine referral hospitals in South-west Nigeria. Nine years’ data were retrieved from medical records, including 699 induced abortions. Independent variable was the method of abortion; dependent variables were complications, need for treatment and mortality. Statistical significance was tested with Chi-square, Fishers’ exact and chi-square for trend tests (p<0.05).ResultsThere were 699 induced abortions amongst 2,463 abortions found in records. Nearly 70% were surgical abortions, but misoprostol use significantly increased over the study period in a linear trend (Χ2 trend: 30.96, P <0.001). Patients who used misoprostol were significantly less likely to have infectious morbidity, genital tract injuries or medical complications. There was no difference in incomplete abortion in the groups. Patients were more likely to have in-patient care with surgical abortions (p<0.001), to need prolonged antibiotic regimens (p = 0.003), need further surgeries or additional specialist care (p = 0.009).ConclusionMisoprostol abortion has significantly increased over time, and was associated with less morbidity and need for further treatment, in this study. It appears to be the safer option.

Uptake of Misoprostol among women seeking abortion in Accra, Ghana

“…This figure, although slightly higher, is similar to the 18% reported by the GSS et al [12] in the 2017 Ghana Maternal Health survey. The figure is however, lower than the 60-83% reported in previous studies in Kumasi [10,29]; but higher than the 12.4% observed in Nigeria [30]. The figures are however higher than those recorded in other parts of the world (1.2%-1.6%) [31][32][33].…”

Inequities in the incidence and safety of abortion in Nigeria

“…Among gynaecological admissions at a Nigerian teaching hospital in recent years, 7.4% were related to treatment of unsafe abortion, 17% of which ultimately resulted in maternal death 9. Findings from gynaecological admissions at nine referral hospitals in Nigeria suggest that, although surgical abortion is still the primary method of abortion, the share of postabortion care (PAC) patients who report first using misoprostol is increasing 10. PAC patients who used misoprostol experienced fewer and less severe complications than PAC patients presenting after a clandestine surgical abortion 10.…”

“…Findings from gynaecological admissions at nine referral hospitals in Nigeria suggest that, although surgical abortion is still the primary method of abortion, the share of postabortion care (PAC) patients who report first using misoprostol is increasing 10. PAC patients who used misoprostol experienced fewer and less severe complications than PAC patients presenting after a clandestine surgical abortion 10. While these population level estimates and facility data are essential to track abortion trends and the public health implications of abortion, we know little about the specifics of its occurrence and characteristics of women who seek abortion, particularly those not seeking facility-based care.…”

Women’s self-reported experiences using misoprostol obtained from drug sellers: a prospective cohort study in Lagos State, Nigeria

“…6 MA drugs, particularly misoprostol, have become more widely available in Nigeria in recent years. [7][8][9] Nigeria has a large market of drug vendors serving informally as the first point of care for diverse health problems, and most medications can be procured without prescription. 10 However, evidence from other studies suggests that drug sellers have poor knowledge of MA drugs, commonly sell medications without packaging or instructions and often provide inadequate or inaccurate information to women about medications, side effects and potential complications.…”