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      A prospective study of complications from comprehensive abortion care services in Nepal.

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          Abstract

          In March 2002, Nepal's Parliament approved legislation to permit abortion on request up to 12 weeks of pregnancy. Between 2004 and 2007, 176 comprehensive abortion care (CAC) service sites were established in Nepal, leading to a rise in safe, legal abortions. Though monitoring systems have been developed, reporting of complications has not always been complete or accurate. The purpose of this study was to report the frequency and type of abortion complications arising from CAC procedures in different types of facilities in Nepal.

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          The magnitude of abortion complications in Kenya.

          Anthony Monyo, Timothy Johnson, F. Gallo … (2005)
          To estimate and describe the magnitude of abortion complications presenting at public hospitals in Kenya. Cross-sectional descriptive study. Hospital-based. Population Records of all women presenting prior to 22 weeks of gestation with abortion-related complications at selected hospitals during a three-week study period. All public tertiary and provincial hospitals were included; stratified random sampling was employed to select a subset of 54 district hospitals nationwide. Data collectors identified 809 patients with abortion complications on all hospital wards and completed a standardised questionnaire for each by extracting information from the patient's hospital record. Incidence, aetiology, morbidity and mortality of abortion complications. Most women (80%) presented with incomplete abortion. Approximately 34% of the women had reached the second trimester of pregnancy. Adolescents (14-19 years old) accounted for approximately 16% of the study sample. Manual vacuum aspiration was used to manage 80% of first trimester cases. The projected annual number of women with abortion complications admitted to public hospitals in Kenya is 20,893. The case fatality rate was estimated to be 0.87% (95% CI 0.71-1.02%), so an estimated 182 (95% CI 148-213) of these women die annually. The annual incidence of incomplete abortion and other abortion-related complications per 1000 women aged 15 to 49 years is projected to be 3.03. The high rate of abortion-related morbidity and mortality documented in the study highlights the critical need to address the issue of unsafe abortion in Kenya.
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            Antibiotics at the time of induced abortion: the case for universal prophylaxis based on a meta-analysis.

            D. Jay Grimes, G Sawaya, K. Kerlikowske … (1996)
            To determine the efficacy of periabortal antibiotics in preventing postabortal upper genital tract infection using data from published trials. We performed a literature search of all studies published from January 1966 to September 1, 1994, using MEDLINE, and we manually searched bibliographies of published articles. MEDLINE search terms included: abortion, infection, prophylaxis, antibiotics, pelvic inflammatory disease (PID), and suction curettage. Randomized, controlled trials comparing antibiotics with placebo in women undergoing suction curettage abortion before 16 weeks' gestation were identified. Data were extracted independently by two reviewers, one of whom was blinded to journal, year of publication, authors, and institution. Data from 12 studies were combined using meta-analytic techniques based on a fixed-effects model. The overall summary relative risk (RR) estimate for developing postabortal upper genital tract infection in women receiving antibiotic therapy compared with those receiving placebo was 0.58 (95% confidence interval [CI] 0.47-0.71). Of high-risk women, those with a history of PID had a summary RR estimate of 0.56 (95% CI 0.37-0.84); women with a positive chlamydia culture at abortion had a summary RR estimate of 0.38 (95% CI 0.15-0.92). Of low-risk women, those with no reported history of PID had a summary RR estimate of 0.65 (95% CI 0.47-0.90); in women with a negative chlamydia culture, the summary RR estimate was 0.63 (95% CI 0.42-0.97). The lowest summary RR estimate was among women drawn from populations with a low incidence (5-6%) of postabortal infection (summary RR estimate 0.22, 95% CI 0.11-0.42). The overall 42% decreased risk of infection in women given periabortal antibiotics is similar to the risk reduction demonstrable when only studies published before 1985 are combined (summary RR estimate 0.63, 95% CI 0.44-0.89). Our meta-analysis revealed a substantial protective effect of antibiotics in all subgroups of women undergoing therapeutic abortion, even women in low-risk groups. No more placebo-controlled trials should be performed, because women assigned to placebo are exposed to preventable risk. Routine use of periabortal antibiotics in the United States may prevent up to half of all cases of postabortal infections.
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              Abortion law reform in Nepal: women's right to life and health.

              J Barak, Nigel C. Bird, S Kishore … (2004)
              In Nepal, the effects of the low social status of women and lack of access to health care and family planning have resulted in a maternal mortality ratio that is among the highest in South Asia. By the mid-1990s, the contribution of unsafe abortions to maternal deaths and morbidity was acknowledged by key individuals in the Ministry of Health and Department of Health Services. Advocacy for abortion law reform over several decades culminated in the passage of a new law on abortion in 2002. The parliamentary process took almost four years from the tabling of the bill. Almost two years elapsed between the passage of the bill and approval of the Procedural Order for implementing it This paper describes the development of policy and programme strategies for implementing the new law, led by the government in collaboration with NGOs, donors and other stakeholders. During that time, documents required for implementation were prepared, training of service providers was begun and a model service delivery and training site was established in Kathmandu Maternity Hospital. Simple systems to enable rapid expansion of services and a women-friendly approach were devised, promoting universal availability of affordable services provided by physicians and eventually nurses, the latter particularly in remote and rural areas, where 88% of the population live.
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                Author and article information

                Journal
                Journal ID (iso-abbrev): BMC Public Health
                Title: BMC public health
                Publisher: Springer Science and Business Media LLC
                ISSN (Electronic): 1471-2458
                ISSN (Print): 1471-2458
                Publication date (Electronic): Jan 05 2012
                Volume: 12
                Affiliations
                [1 ] andersenk@ipas.org
                Article
                Publisher Item ID: 1471-2458-12-9
                DOI: 10.1186/1471-2458-12-9
                PMC ID: 3315730
                PubMed ID: 22221895
                SO-VID: 777ed830-f5e8-425b-a228-e97fd3adaf55
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