COMPLICATIONS OF INDUCED ABORTION COMPARED TO THOSE OF SPONTANEOUS ABORTION IN YAOUNDÉ-CAMEROON: A COHORT STUDY

Abstract

BACKGROUND: Induced abortion is a major public health challenge worldwide particularly in developing country. It is one of the leading causes of maternal death. However some spontaneous abortions can also lead to major complications. OBJECTIVE: To compare the complications of induced abortion with those of spontaneous abortion in Yaoundé. METHODOLOGY: The researchers conducted a cohort study from November 1st 2019 to May 31st, 2020 with prospective data collection in the gynecology departments of the Yaoundé Gyneco-Obstetric and Pediatric Hospital and the Yaoundé Central Hospital. . The participants were all patients admitted for abortion and who gave their informed consent. All patients known to have co-morbidities were excluded because it could be confused with one or more complications of abortion. Patients lost during the period of follow-up were also excluded. Sampling was consecutive and exhaustive, with a minimum sample size calculated of 40 participants for each group. The questionnaire was used to collect the data which were analyzed using SPSS 23.0. To compare the different observations, the Odds Ratio with 95% confident interval and the significance threshold was set at less than 5%. RESULTS: A total of one hundred and fifteen (115) abortion cases were included during our study period: 56 for the induced abortion group and 59 for the spontaneous group. Patients with induced abortion were significantly younger than those with spontaneous one (median age: 24 years [20-30] vs. 28 years [24-32]; p = 0.013). Clinically, fever was significantly more common in induced abortion group (28.6%) than in spontaneous one (6.8%) (p= 0.004). The rate of complication was higher in the induced abortion group. Induced abortion increases the risk of sepsis by 4.48. Some complications were observed only in cases with induced abortion, namely uterine perforation (8.9%), pelvic peritonitis (7.1%), septic shock (3.6%) and intestinal lesions (1.8%). However, haemorrhage and anaemia were observed in both groups with no significant difference. In terms of management, induced abortion carries twice the risk of blood transfusion (p = 0.030). The overall post-abortion contraceptive use rate was only 40.9%. In terms of prognosis, the lethality rate was 3.6% among patients with induced abortion. CONCLUSION: Induced abortion, compared to spontaneous abortion, is the prerogative of adolescents. Abortion remains a major provider of maternal morbidity and mortality in the poor settings, where the unmet needs of contraception are high. We recommend a full implementation of post abortion care.