Abortion-Related Near-Miss at KIST Medical College and Teaching Hospital

Sunita Bhandari; Heera Tuladhar; Yam Dwa; Meenu Maharjan; Smrity Maskey; Manisha Bajracharya; Minaxi Thakur

Sunita Bhandari Department of Obs/Gyn, KIST Medical College Teaching Hospital
Heera Tuladhar Department of Obs/Gyn, KIST Medical College Teaching Hospital
Yam Dwa Department of Obs/Gyn, KIST Medical College Teaching Hospital
Meenu Maharjan Department of Obs/Gyn, KIST Medical College Teaching Hospital
Smrity Maskey Department of Obs/Gyn, KIST Medical College Teaching Hospital
Manisha Bajracharya Department of Obs/Gyn, KIST Medical College Teaching Hospital
Minaxi Thakur Department of Obs/Gyn, KIST Medical College Teaching Hospital

Abstract

Introduction: This study aims to determine the frequency of abortion-related near-miss events by applying WHO near-miss criteria, the complications and its management associated with the near-miss events encountered at KIST Medical College Teaching Hospital.

Methods: This hospital based descriptive study was conducted from January 2015 to July 2018 in the department of Obstetrics and Gynecology, KIST Medical College and Teaching Hospital. Case eligibility was defined by WHO Near-Miss Guidelines. Medical records of the patients were used to generate the data. The data generated and analyzed included age and parity, clinical conditions for near-miss and management of abortion related near-miss complications. Results were presented in mean ± SD and percentages, wherever applicable.

Results: There were 5041 total admission in the study period of which 4073 accounts for Obstetric admission and 968 gynecological admissions. There were 320 abortion-related admissions (33.05%) with 37 abortion-related near-miss cases. Near miss morbidity constituted 11.6% of abortion-related admissions. The major factors contributing near-miss events were severe anemia (45.92%) followed by septic shock (27.02%), hypovolemic shock (21.62%), renal failure (2.7%) and uterine perforation (2.7%). Blood transfusion was needed in 24 cases (64.9%); 21 cases (56.7%) required transfusion <5 unit and 3 cases (8.2%) required massive blood transfusion (>5units), 11 cases(29.7%) required ICU management, 1 case(2.7%) required hemodialysis and 1 case(2.7%) required subtotal hysterectomy.

Conclusions: Unsafe abortion is a leading and easily preventable cause of maternal morbidity and mortality.Despite various efforts and liberalization of abortion laws, unsafe abortion remain the major public health concern in developing countries.Abortion-related near-miss cases, are a useful indicator of the most unsafe abortions and a proxy for mortality.

Keywords: Abortion-related near miss; unsafe abortion; WHO criteria