Severity and management of postabortion complications among women in Zimbabwe, 2016: a cross-sectional study
Severity and management of postabortion complications among women in Zimbabwe, 2016: a cross-sectional study
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DOI：
10.1136/bmjopen-2017-019658
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发表时间：
2018-05-01
期刊：
影响因子：
2.9
通讯作者：
Chipato, Tsungai
中科院分区：
文献类型：
--
作者：
Madziyire, Mugove Gerald;Polis, Chelsea B.;Chipato, Tsungai
目的流产并发症的发病率和死亡率都很高。我们的目的是评估津巴布韦流产并发症（诱发或自发）的严重程度和相关因素，以及流产后护理（PAC）的管理。设计前瞻性，基于设施的28天调查妇女寻求PAC和他们的提供者。在津巴布韦建立127个有能力提供PAC的设施，包括所有中央和省级医院，以及抽样的初级保健中心（30%）、地区/综合/教会医院（52%）、私人（77%）和非政府组织（68%）设施。研究期间有1002名出现流产并发症的妇女。主要结局指标流产并发症及其相关因素的严重程度、就诊延误和并发症的临床处理。结果总的来说，59%的女性出现了轻度并发症，19%为中度，19%为重度，3%为近危，0.2%死亡。从出现并发症到接受治疗的平均时间为47小时；许多延误都是由于缺乏资金。农村、年轻、未婚、受教育程度较低、孕龄较晚或生育较多子女的妇女更有可能出现更严重的并发症。大多数妇女接受医生治疗（91%）。采用的主要管理程序为扩张刮除/扩张抽吸（75%），12%采用手动真空抽吸（MVA）或电真空抽吸，11%采用米索前列醇处理。出院时，提供者报告43%的妇女接受了现代避孕措施。津巴布韦妇女经历了相当多的与堕胎有关的发病率，特别是年轻、农村或受教育程度较低的妇女。在津巴布韦，通过放宽堕堕法、在初级保健中心提供PAC和培训护士使用米索前列醇和MVA进行医疗后送，可以减少与堕胎有关的发病率和随之而来的死亡率。需要定期就项目评估委员会准则进行在职培训，并进行后续审计，以确保遵守并提供设备、用品和训练有素的工作人员。
Objectives Abortion complications cause significant morbidity and mortality. We aimed to assess the severity and factors associated with abortion complications (induced or spontaneous), and the management of postabortion care (PAC) in Zimbabwe.Design Prospective, facility-based 28 day survey among women seeking PAC and their providers.Setting 127 facilities in Zimbabwe with the capacity to provide PAC, including all central and provincial hospitals, and a sample of primary health centres (30%), district/general/mission hospitals (52%), private (77%) and non-governmental organisation (NGO) (68%) facilities.Participants 1002 women presenting with abortion complications during the study period.Main outcome measures Severity of abortion complications and associated factors, delays in care seeking, and clinical management of complications.Results Overall, 59% of women had complications classified as mild, 19% as moderate, 19% as severe, 3% as near miss and 0.2% died. A median of 47 hours elapsed between experiencing complication and receiving treatment; many delays were due to a lack of finances. Women who were rural, younger, not in union, less educated, at later gestational ages or who had more children were significantly more likely to have higher severity complications. Most women were treated by doctors (91%). The main management procedure used was dilatation and curettage/dilatation and evacuation (75%), while 12% had manual vacuum aspiration (MVA) or electrical vacuum aspiration and 11% were managed with misoprostol. At discharge, providers reported that 43% of women received modern contraception.Conclusion Zimbabwean women experience considerable abortion-related morbidity, particularly young, rural or less educated women. Abortion-related morbidity and concomitant mortality could be reduced in Zimbabwe by liberalising the abortion law, providing PAC in primary health centres, and training nurses to use medical evacuation with misoprostol and MVA. Regular in-service training on PAC guidelines with follow-up audits are needed to ensure compliance and availability of equipment, supplies and trained staff.