The Determinants and Outcomes of Second Trimester Abortion at the University Teaching Hospital

Abstract

Background: Mid trimester abortion constitutes 10-15% of all induced abortions worldwide and accounts for the majority of complications. In Africa, studies demonstrating the proportion of second trimester abortions are few.  However to appropriately intervene with a view to reducing the morbidity and mortality due to mid trimester   abortions, the determinants in our setting must be established as well as the outcomes of uterine evacuation in  this trimester. The aim of this study was to explore the determinants and outcomes of second trimester abortions at UTH.

Design: Cross sectional non interventional descriptive study.

Setting: University Teaching Hospital, a tertiary referral hospital in Lusaka, Zambia

Population: Pregnant women requiring second trimester abortion care.

Methods: A total of 145 second trimester cases were seen, involving women aged 13-46 years of age either
requesting termination of pregnancy or presenting with spontaneous or induced abortion. The enrolled study
participants all underwent a standard clinical assessment during which their respective clinical findings were
recorded on data sheets. Data analysis was done using SPSS version 17.

Results: The point prevalence of second trimester abortion was 15.3%. The mean frequency of abortion per patient was 1. The index abortion was for a first pregnancy in 84% of the women. Out of 145 women who were  admitted 119 (82.1%) were linked to spontaneous abortions, 16(11%) with medically/surgically induced abortion  and 10(6.9%) with self-induced abortions. More women, 128(88%) were not using some form of contraception to  avoid pregnancy. Few, 17(12%) actually used some form of contraception prior to index pregnancy. Five (3.4%)  out of 26 who had induced abortion had desired pregnancy. Of the delay factors, the most frequent was conflict  with partner. Amongst those who had spontaneous abortion, illness was reported as most frequent determinant  (49.7%). It was observed that there was no statistically significant association between seeking care and with any  delay factors. With regard to standard of care or health system factors, overall 89% were provided with  ppropriate uterine evacuation method while the rest were not. Fifty percent did not receive analgesia. The mean time   between expulsion of fetus and uterine evacuation was 4.31 hours. Complications noted included uterine  perforation, hemorrhage, cervical or vaginal lacerations, shock and even death.

Conclusion: The determinants of the second trimester abortion cases at the University Teaching Hospital are social, economic, health system factors, trauma, illness and unknown factors. The outcomes of second trimester  abortion in terms of complications are varied. These are due to patient factors and methods used for uterine  evacuation. The outcomes included uncomplicated complete abortion, retained products of conception,   haemorrhage, uterine perforation, pain, shock, infection, lacerations, delayed vaginal bleeding and death. The  methods of uterine evacuation varied from patient to patient but the overall outcome of the patient was not   significantly affected by this.

Key Words: Second trimester,Abortion, determinants and outcomes.