Management of second trimester abortions at kenyatta national hospital: a five-year cross-sectional study

Abstract

Background Abortion is the spontaneous or induced termination of pregnancy before fetal viability. The world health organization (who) defines it as termination prior to 22 weeks gestation or a fetus weighing less than 500 gms. Abortions occurring in the second trimester account for 10-15% of all abortions but are responsible for two thirds of all complications and thus its management is key in preventing maternal morbidity and mortality. The purpose of this study is to evaluate the management practice of second trimester abortion at kenyatta national hospital, identify any potential pitfalls and address the same. Broad objective: to describe the managemen

t practice and associated outcomes of second trimester abortions at kenyatta national hospital. Study design: this was a descriptive cross-sectional study. Study setting and site: the study was conducted at kenyatta national hospital with data obtained from records of patients previously admitted at the acute gynecological ward. Study population: women of childbearing age, above the age of 18 who sought abortion related care at kenyatta national hospital (knh)l from july 2013 to july 2018. Sample size: a sample of 139 patients, calculated using fisher’s formula of proportions was obtained. Systematic random sampling of patients’ files and records was done and data was collected using a structured questionnaire administered by the principal investigator and analysis done by stata version 12. Data analysis: the study utilized univariate and bivariate analysis: categorical variables were described using frequency tables and continuous variables using the median and mean. Fischer’s exact test was used to evaluate the association between the method of management and outcomes. A p value of <0.05 and 95% confidence interval that doesn’t include the null value were considered significant.

Results: between july 2013 and july 2018, 573 patient records were screened and 372 were found to be eligible. 139 patient records were obtained from these by simple random sampling. Methods used in the management of second trimester abortion were 34%, 32% and 31% respectively for surgical, medical and surgical plus medical interventions. The main surgical method was manual vacuum aspiration while the main medical method was utilization of misoprostol There were no statistically significant differences between method of management and outcome. Conclusion: the prevalence of methods of management of second trimester abortion were similar among the 3 main categories at 34.5%, 32.3% and 31.6% for surgical, medical, surgical and medical management (mva+misoprostol) respectively. The complication rate was 14% and did not vary by method of management.