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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Women's Health 1/2015

Management of abortion complications at a rural hospital in Uganda: a quality assessment by a partially completed criterion-based audit

Zeitschrift:
BMC Women's Health > Ausgabe 1/2015
Autoren:
Natja Mellerup, Bjarke L. Sørensen, Gideon K. Kuriigamba, Martin Rudnicki
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

The study originates from the Department of Obstetrics and Gynaecology, Odense University Hospital, Denmark, but the fieldwork and data collection was carried out at a rural hospital in Uganda. NM developed the study design, participated in the selection of audit criteria, performed the collecting of data, analysis and interpretation of data, drafted the article, and did final approval of the version to be published. BLS participated in development of study design by critically revising the audit criteria, repeated critical revision of analysis and interpretation, revised the article, and did final approval of the version to be published. GKK participated in development of study design by critically revising the audit criteria, repeated critical revision of analysis and interpretation, revised the article, and did final approval of the version to be published. MR participated in development of study design by critically revising the audit criteria, repeated critical revision of analysis and interpretation, revised the article, and did final approval of the version to be published.

Abstract

Background

Complications of unsafe abortion are a major contributor to maternal deaths in developing countries. This study aimed to evaluate the clinical assessment for life-threatening complications and the following management in women admitted with complications from abortions at a rural hospital in Uganda.

Methods

A partially completed criterion-based audit was conducted comparing actual to optimal care. The audit criteria cover initial clinical assessment of vital signs and management of common severe complications such as sepsis and haemorrhage. Sepsis shall be managed by immediate evacuation of the uterus and antibiotics in relation to and after surgical management. Shock by aggressive rehydration followed by evacuation.
In total 238 women admitted between January 2007 and April 2012 were included. Complications were categorized as incomplete, threatened, inevitable, missed or septic abortion and by trimester. Actual management was compared to the audit criteria and presented by descriptive statistics.

Results

Fifty six per cent of the women were in second trimester. Abortion complications were distributed as follows: 53 % incomplete abortions, 28 % threatened abortions, 12 % inevitable abortions, 4 % missed abortions and 3 % septic abortions. Only one of 238 cases met all criteria of optimal clinical assessment and management. Thus, vital signs were measured in 3 %, antibiotic criteria was met in 59 % of the cases, intravenous fluid resuscitation was administered to 35 % of women with hypotension and pain was managed in 87 % of the cases. Sharp curettage was used in 69 % of those surgically evacuated and manual vacuum aspiration in 14 %. In total 3 % of the abortions were categorized as unsafe. Two of eight women with septic abortion had evacuation performed during admission-day, one woman died due to septic abortion and one from severe haemorrhage.

Conclusions

Guidelines were not followed and suboptimal assessment or management was observed in all but one case. This was especially due to missing documentation of vital signs necessary to diagnose life-threatening complications, poor fluid resuscitation at signs of shock, and delayed evacuation of septic abortion.
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