The Contribution of Unsafe Abortions to Gynaecological Emergencies and Mortality –Five Year Experience Of Jos University Teaching Hospital, Nigeria

Abstract

Context: Unsafe abortions remain a significant cause of maternal mortality and morbidity in Nigeria. They increase the burden on the already stretched health systems with majority coming in as emergencies and contribute to maternal morbidity and mortality. It is important to ascertain these contributions in order to prevent them. Objectives: This study aims at reviewing the contributions of unsafe abortions to gynaecological emergencies, the pattern of terminations and complications, as well as morbidity and mortality among women in Jos University Teaching Hospital (JUTH). Methodology: The 120 cases of unsafe abortions managed from January 2001 to December 2005 at the Jos University Teaching Hospital were reviewed. Information was retrieved from patients' case notes in the various gynaecological units as well as daily ward reports and analyzed using EPI Info statistical software version 3.3. Results: Induced abortions contributed 4.8% of the 2,495 gynaecological emergencies and 12.64% maternal deaths; with the maternal mortality ratio being 891/100,000 live births. The age range was 14-45 years, with the majority 33% (40) being adolescents. Singles contributed 70.8% (85), married 26.7 %(32), and separated/divorced 2.5 % (3). Parity range was 0-10, with 66.4% being nulliparous and 21.1% grand-multipara. At presentation, 26 (21.7%) denied termination of pregnancy. Modal gestational age was 13 weeks. Surgical termination occurred in 75 (62.8%) of patients. There were 51 abortions (42.5%) procured at private clinics and 28 (23.1%) at chemists and homes. Most of the patients 60.8% (73) were first timers. Most of the complications of induced abortion occurred in the first week and were mainly: incomplete abortion, septicemia, uterine perforation, acute renal failure, pelvic abscess and tetanus. Uterine evacuation was done for 47.8%, laparotomy for 17.5% and blood transfusion for 23.3% of the patients. Days on admission ranged from 0-64 days. The case fatality rate was 11.2% with 30.8%of the deaths attributed to the use of herbal concoctions. Conclusion: The morbidity and mortality from unsafe abortions remains high. Adolescents contribute high numbers warranting programs for adolescent reproductive health services and improved contraceptive utilization.