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Draganchuk J, Lungu SA, Patel T, Chang'ombe M. Clandestine abortion resulting in uterine perforation and a retained foreign body led to generalized peritonitis: a case report from Lilongwe, Malawi. AJOG Glob Rep 2024; 4:100328. [PMID: 38586616 PMCID: PMC10994963 DOI: 10.1016/j.xagr.2024.100328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
Abortion is criminalized in Malawi in the absence of a life-threatening condition. Consequently, women often undergo unsafe abortions. A large proportion of abortions performed in Malawi require subsequent treatment at a healthcare facility. We describe the case of a 17-year-old who presented with generalized peritonitis and was found intraoperatively to have a necrotic and perforated uterus with a stick retained in her abdominopelvic cavity from a clandestine abortion. This case demonstrates the need for awareness and vigilance among healthcare providers in all specialties to suspect surgical abortion complications as a cause of generalized peritonitis and points to the need for further studies on the optimal management of such patients.
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Affiliation(s)
- Jennifer Draganchuk
- Division of Global Women's Health, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX (Drs Draganchuk and Patel)
| | - Stellah Ashley Lungu
- Department of Obstetrics and Gynecology, Kamuzu Central Hospital, Lilongwe, Malawi (Drs Lungu and Chang'ombe)
- Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi (Dr Lungu)
| | - Tulsi Patel
- Division of Global Women's Health, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX (Drs Draganchuk and Patel)
| | - Mtisunge Chang'ombe
- Department of Obstetrics and Gynecology, Kamuzu Central Hospital, Lilongwe, Malawi (Drs Lungu and Chang'ombe)
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Rafferty K, Longbons T. Understanding Women's Communication with Their Providers During Medication Abortion and Abortion Pill Reversal: An Exploratory Analysis. Linacre Q 2023; 90:172-181. [PMID: 37325429 PMCID: PMC10265391 DOI: 10.1177/00243639231153724] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Introduction/Objective: Medication abortion is a common experience for women in the United States, now totaling over 50% of all abortions. The purpose of this exploratory analysis is to understand women's medication abortion and abortion pill reversal decision-making experiences, with a particular focus on their communication with their medical providers. Methods: We surveyed women who contacted Heartbeat International to inquire about abortion pill reversal. Eligible women had to complete a minimum of the 2-week progesterone protocol in order to answer the questions on the electronic survey about their medication abortion and abortion pill reversal decisions. We assessed decision difficulty using a Likert scale and provider communication using the Questionnaire on the Quality of Physician-Patient (QQPPI) and analyzed women's narratives about their experiences using thematic analysis. Results: Thirty-three respondents met the eligibility criteria and filled out the QQPPI and decision-difficulty scales. Using the QQPPI scale, women scored their communication with their APR providers as significantly better than their communication with their abortion providers (p < 0.0001). Women reported that choosing medication abortion was significantly more difficult than choosing abortion pill reversal (p < 0.0001). White women, women with college degrees, and women who were not in a relationship with the father of the child reported more difficulty in choosing APR. Conclusion: As the number of women who contact the national hotline to inquire about abortion pill reversal increases, the need to understand the experiences of this growing population of women becomes more salient. This need is particularly important for health care providers who prescribe medication abortion and abortion pill reversal. The quality of the physician-patient interaction is essential to providing effective medical care to pregnant women.
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Wolomby-Molondo JJ, Calvert C, Seguin R, Qureshi Z, Tunçalp Ö, Filippi V. The relationship between insecurity and the quality of hospital care provided to women with abortion-related complications in the Democratic Republic of Congo: A cross-sectional analysis. Int J Gynaecol Obstet 2021; 156 Suppl 1:20-26. [PMID: 34888865 DOI: 10.1002/ijgo.14031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To examine the relationship between insecurity and quality of care provided for abortion complications in high-volume hospitals in the Democratic Republic of Congo (DRC). METHODS Using the WHO Multi-Country Survey on Abortion complications, we analyzed data for 1007 women who received care in 24 facilities in DRC. For inputs of care, we calculated the percentage of facilities in secure and insecure areas meeting 12 readiness criteria for infrastructure and capability. For process and outcomes of care, we estimated the association between security and eight indicators using generalized estimating equation models. RESULTS Facilities in secure areas were more likely to report functioning electricity (93.3% vs 66.7%), availability of an obstetrician 24/7 (42.9% vs 28.6%), and the ability to offer several short-acting contraceptives (83.3% vs 57.1%). However, a higher percentage of facilities in insecure areas reported the availability of a telephone or radio (100% vs 80.0%). Women in insecure areas appeared more likely to experience poor quality clinical care overall than women in secure areas (aOR 2.56; 95% CI, 1.13-5.82, P = 0.03). However, there was no association between security and incomplete medical records (P = 0.20), use of dilatation and curettage (D&C) (P = 0.84), women reporting poor experience of care (P = 0.22), satisfaction with care (P = 0.25), and severe maternal outcomes (P = 0.56). There was weak evidence of an association between security and nonreceipt of contraceptives (P = 0.07), with women in insecure areas 70% less likely to report no contraception (aOR 0.31, 95% CI, 0.09-1.09). Use of D&C was high in secure (43.7%) and insecure (60.4%) areas. CONCLUSION Quality of care did not seem to be very different in secure and insecure areas in DRC, except for some key infrastructure, supply, and human resources elements. The frequent use of D&C for uterine evacuation, the lack of good record keeping, and the lack of contraceptives should be urgently addressed.
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Affiliation(s)
- Jean-José Wolomby-Molondo
- Département de Gynécologie et Obstétrique, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Clara Calvert
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Zahida Qureshi
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Véronique Filippi
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Govule P, Baumann S, Dossou JP, Calvert C, Goufodji S, Mehrtash H, Tuncalp Ö, Adu-Bonsaffoh K, Compaore R, Filippi V. Experiences of women seeking care for abortion complications in health facilities: Secondary analysis of the WHO Multi-Country Survey on Abortion in 11 African countries. Int J Gynaecol Obstet 2021; 156 Suppl 1:44-52. [PMID: 34866183 DOI: 10.1002/ijgo.13987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Despite evidence of acute and long-term consequences of suboptimal experiences of care, standardized measurements across countries remain limited, particularly for postabortion care. We aimed to determine the proportion of women reporting negative experiences of care for abortion complications, identify risk factors, and assess the potential association with complication severity. METHODS Data were sourced from the WHO Multi-Country Survey on Abortion for women who received facility-based care for abortion complications in 11 African countries. We measured women's experiences of care with eight questions from an audio computer-assisted self-interview related to respect, communication, and support. Multivariable generalized estimating equations were used for analysis. RESULTS There were 2918 women in the study sample and 1821 (62%) reported at least one negative experience of postabortion care. Participants who were aged under 30 years, single, of low socioeconomic status, and economically dependent had higher odds of negative experiences. Living in West or Central Africa, rather than East Africa, was also associated with reportedly worse care. The influence of complication severity on experience of care appeared significant, such that women with moderate and severe complications had 12% and 40% higher odds of reporting negative experiences, respectively. CONCLUSION There were widespread reports of negative experiences of care among women receiving treatment for abortion complications in health facilities. Our findings contribute to the scant understanding of the risk factors for negative experiences of postabortion care and highlight the need to address harmful provider biases and behaviors, alleviate health system constraints, and empower women in demanding better care.
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Affiliation(s)
- Philip Govule
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Sasha Baumann
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Jean-Paul Dossou
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Bénin
| | - Clara Calvert
- Centre for Global Health, Usher Institute, University of Edinburgh, Scotland, UK
| | - Sourou Goufodji
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Bénin
| | - Hedieh Mehrtash
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Özge Tuncalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Kwame Adu-Bonsaffoh
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Accra, Ghana.,Department of Obstetrics and Gynecology, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Rachidatou Compaore
- Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Véronique Filippi
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Abstract
Complications from abortion, while rare, are to be expected, as with any medical procedure. While the vast majority of serious abortion complications occur in parts of the world where abortion is legally restricted, legal access to abortion is not a guarantee of safety, particularly in regions where abortion is highly stigmatised. Women who seek abortion and caregivers who help them are universally negatively “marked” by their association with abortion. While attention to abortion stigma as a sociological phenomenon is growing, the clinical implications of abortion stigma – particularly its impact on abortion complications – have received less consideration. Here, we explore the intersections of abortion stigma and clinical complications, in three regions of the world with different legal climates. Using narratives shared by abortion caregivers, we conducted thematic analysis to explore the ways in which stigma contributes, both directly and indirectly, to abortion complications, makes them more difficult to treat, and impacts the ways in which they are resolved. In each narrative, stigma played a key role in the origin, management and outcome of the complication. We present a conceptual framework for understanding the many ways in which stigma contributes to complications, and the ways in which stigma and complications reinforce one another. We present a range of strategies to manage stigma which may prove effective in reducing abortion complications.
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Affiliation(s)
- Meghan Seewald
- Project Manager, University of Michigan, 1500 E. Medical Center Dr. L4000 University Hospital South, Ann Arbor, MI 48109, USA. Correspondence:
| | - Lisa A Martin
- Associate Professor, University of Michigan Dearborn, Departments of Health Policy Studies and Women's and Gender Studies, Dearborn, MI, USA
| | - Lina Echeverri
- Senior Program Learning Officer, Planned Parenthood Global, Miami, FL, USA
| | - Jesse Njunguru
- Sexual and Reproductive Health and Rights Independent Consultant, Nairobi, Kenya
| | - Jane A Hassinger
- Research Program Lead, University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, MI, USA
| | - Lisa H Harris
- Professor, University of Michigan, Department of Obstetrics and Gynecology, Department of Women's Studies, Ann Arbor, MI, USA
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de Almeida N, Teixeira A, Capoco Sachiteque A, Molina JR, Dos Prazeres Tavares H, Ramalho C. Characterisation of induced abortion and consequences to women's health at Hospital Central do Huambo - Angola. J OBSTET GYNAECOL 2019; 40:558-563. [PMID: 31475598 DOI: 10.1080/01443615.2019.1635096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To characterise patients with abortion in Huambo, Angola, we have undertaken a descriptive, longitudinal, prospective survey. A structured questionnaire was applied to 715 patients. The study variables were grouped in socio-demographic and clinical-epidemiological variables. There were 29.8% women were aged 20-24, 45.6% had primary education, 41.1% were single and 26.9% worked as a non-formal salesperson. Menarche occurred at 16-18 years (55.5%), first sexual intercourse at 13-15 years (40.3%) and 74.8% did not use contraceptive methods. Abortion was of indeterminate type in 84.3% and 79.3% had had a previous abortion. Serious complications occurred in 8.0% with six maternal deaths (0.8%). Age of menarche and age at onset of sexual activity are interdependent variables (p ≤ .001), the earlier menarche appears, the earlier sexual activity begins. When there was a history of abortion, new abortions occurred earlier (p ≤ .001) and were of indeterminate type (89%). Indeterminate induced abortion is influenced by socioeconomic, educational and political conditions and continues to be a frequent cause of morbidity and mortality.Impact statementWhat is already known on this subject? Unsafe abortion contributes greatly to maternal morbidity and mortality, principally in countries with restrictive abortion laws. The relationship between socio-educational level and unwanted pregnancies is consensual.What the results of this study add? Early initiation of sexual activity combined with non-contraception contributes to unwanted pregnancy and consequent unsafe abortion. Most of the women had previously had an abortion.What the implications are of these findings for clinical practice and/or further research? It is necessary to develop access to adequate information and family planning to combat unwanted pregnancies. It is also important to evaluate long-term consequences of unsafe abortion.
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Affiliation(s)
- Natércia de Almeida
- Serviço de Ginecologia e Obstetrícia, Hospital Central do Huambo, Huambo, Angola.,Universidade José Eduardo dos Santos, Huambo, Angola
| | | | | | - José R Molina
- Universidade José Eduardo dos Santos, Huambo, Angola
| | - Hamilton Dos Prazeres Tavares
- Universidade José Eduardo dos Santos, Huambo, Angola.,Serviço de Ginecologia e Obstetrícia, Hospital Municipal Da Caála, Huambo, Angola
| | - Carla Ramalho
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Centro Hospitalar Universitário S. João, EPE, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
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Watrowski R, Babbel B, Gitsch G. Delivery through cervicovaginal fistula - literature review and case report. J Matern Fetal Neonatal Med 2017; 32:864-869. [PMID: 28969481 DOI: 10.1080/14767058.2017.1387899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Less than 10 deliveries via cervicovaginal fistula (CVF) with closed cervical os were reported so far. In the majority of cases, the patients had a history of induced abortions. The CVF was usually recognized due to postpartum hemorrhage. The facilitating role of prostaglandins used for labor induction was supposed. In all cases, the babies remained unaffected by the delivery route. We report a new case of a 37-year-old gravida 2, para 0, with a history of a paracervical tear following a first trimester abortion 11 years ago. The abortion and the laceration were not reported in the current obstetrical documentation. After labor induction using oral misoprostol in the 41 + 5 weeks of pregnancy, the patient delivered a healthy baby through a left-sided CVF, which imposed as bleeding paracervical laceration, 6 cm in diameter, extending to the vaginal fornix in the 3 o'clock position. The cervical os was only 1-1.5 cm dilated and imposed as an inelastic band ("squid ring") in the 9 o'clock position. The laceration was sutured under spinal anesthesia. The patient recovered quickly, and the postpartum hemoglobin drop was 2.8 g/dl. In conclusion, the possibility of CVF should be considered in women with a history of induced abortion.
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Affiliation(s)
- Rafał Watrowski
- a Department of Gynecology and Obstetrics , St Josefskrankenhaus, Teaching Hospital of the University of Freiburg , Freiburg , Germany
| | - Burghardt Babbel
- a Department of Gynecology and Obstetrics , St Josefskrankenhaus, Teaching Hospital of the University of Freiburg , Freiburg , Germany
| | - Gerald Gitsch
- b Department of Obstetrics and Gynecology , Medical Center - University of Freiburg , Freiburg , Germany
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Abstract
Background: Unwanted pregnancies and unsafe abortion pose
major health risks to women in the reproductive age group. Female
undergraduates are particularly exposed to these risks. This study
was carried out to assess the knowledge about complications and
practice of abortion among female undergraduates of the
University of Ibadan. Methods: A cross-sectional study was conducted using structured,
self-administered questionnaires, to collect data on respondents’
socio-demographic characteristics, sexual behaviour, knowledge
about various complications of abortion and practice of abortion.
Data was analyzed using SPSS version 14. Results: A total of 425 students were interviewed, mean age of
the undergraduates was 21.5± 2.8 years. Overall, 122 (29%) of the
respondents had ever had sexual intercourse. Twenty five percent
of those who were sexually active had ever been pregnant and
90% had terminated the pregnancy. The most common reason
given for termination was that pregnancy was unplanned for. Most
of the respondents 354 (83.3%) had a good knowledge about
complications of abortion and mean knowledge score was
4.01±1.58 (range 0-5). Conclusion: This group of students were aware of the risks
associated with unsafe abortion; however, the abortion rate was
still high. Sexual reproductive health interventions are needed on
campus in order to equip female undergraduates with
comprehensive knowledge and skills to reduce the likelihood of
unplanned pregnancies
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Affiliation(s)
- E O Cadmus
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
| | - E T Owoaje
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
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