A four-year retrospective review of postabortal surgical complications at the central maternity Yaounde, Cameroon

Abstract

In Cameroon as in most African countries, the law on abortion is restrictive. Consequently most unwanted pregnancies are terminated clandestinely with the known associated high morbidity and mortality rates. We therefore decided to carry-out a retrospective cross-sectional descriptive study in order to determine the proportion of women operated for complication of induced abortions, describe the operative findings and associated morbidity, and the different treatment modalities and finally evaluate the outcome. The most affected groups were adolescents 15-19 years (30%) and single women and widows (30%). The mean gravidity and parity in the sample population were 3 and 1.7 respectively. Purulent collection in the peritoneum was observed in 78% of the patients. The volume of collection varied between 20 and 6000 ml with a mean of 1206ml. A rent or perforation was found on the uterus in 27(54%) of the patients. Perforation occurred mostly in the fundus, followed by the posterior, the anterior and lateral walls of the uterus. Associated lesions were found on the small bowel (10%), sigmoid (4%), bladder (2%) and omentum (4%). The corpus of the uterus was gangrenous in 12% of the patients. Inflammatory changes usually accompanied the infectious process. A frozen pelvis was found in 12% of the patients. An occlusive and/or pseudo-occlusive process was noted in 6% of the patients. All the patients had peritoneal washing with at least three litres of saline and drains left in the pouch of Douglas and/ or the paracolic gutter. The uterine perforation was repaired in 18 patients; 5 patients had subtotal hysterectomy; one patient had a total hysterectomy and three were left to heal by granulation. Only 4% of the patients were discharged within 10 days of hospitalisation. The maternal mortality rate in this study was 1400/100000. From this study it is evident that unsafe abortion is associated with an increased maternal morbidity and mortality. The issue of abortion is a delicate one in our country and most developing countries, presenting a complex moral and ethical dilemma. Most abortion laws in the developing countries, inherited from the former colonial powers, have remained stagnant for the past four decades, despite the fact that social values regarding sex and pregnancy have greatly changed. Although the legalisation on abortion in some developing countries have not positively influenced the incidence, reviewing the current law and policy on abortion to ensure that safe abortion services are made available to all women in our environment must be considered. The training of abortion providers may also help reduce the risk of unsafe abortions in our environment.

Clinics in Mother and Child Health Vol. 2(2) 2005: 359-363