Iris Publishers_World Journal of Gynecology & Womens Health (WJGWH)

Practice of Manual Intrauterine Aspiration for Post- Abortion Care (PAC): Prospective Study of 137 Cases at Owendo’s CHU Maternity Hospital

Abstract

Objective: Describe and analyze the practice of MIA in our environment with a view of contributing to the reduction of morbidity and maternal mortality.
Methodology: Descriptive and analytical cross-sectional study, conducted at the motherhood of Owendo’s CHU for 24 months, from 1 January 2017 to 31 December 2018. All women who consulted for incomplete abortions with gestational terms below 12 SA were enrolled. The management consisted of uterine evacuation by MIA. For each patient we studied socio-demographic and pregnancy variables, MIA practice, morbidity and maternal mortality.
Results: One hundred and thirty-seven patients were eligible, representing a frequency of 5.5%. The average age of patients was 26.58±1.68 years, with predominance for 16-24 years old. The mean gestational age was 8.13±1.57 SA, 76 cases (55.47%) were aborted and 69 cases (90.79%) were clandestine. The treatment consisted of uterine evacuation. In 89 cases (64.96%). This was done with the electric vacuum cleaner (EMIA) versus 48 cases (35.04) for SMIA. The use of general anesthesia was necessary for 12 cases (8.75%), medical resuscitation 9 cases (6.57%) and resuscitation 1 case (0.73%) with p-value equal to 0.001 and 0.01 respectively for induced abortions. The average length of hospital stay was 1.8±2.08 hours. No maternal deaths were observed.
Keywords: Abortion care after abortion; MIA-Maternal death

Introduction

According to the WHO, induced abortion today is one of the frequent complications of the first trimester of pregnancy and one of the pillars responsible for maternal deaths in low-income countries [1,2]. Worldwide, 20 million at-risk abortions and 80000 deaths per year are recorded or 1/8 deaths. Africa has 3.7 million and 23 miles of deaths as a result of these complications [3]. Abortion is a public health problem that affects women of all ages, but especially young women who are less financially well off and less informed about family planning services. Moreover, these are most often advanced clinical forms and their management is often delayed [1]. This delay is multifactorial. In 2009, a series produced by Mayi-Tsonga and al. At the Libreville University Hospital showed that women died from unsafe abortions. These deaths were related to long delays in receiving emergency obstetric care (EOC) [4]. The authorities then supported the recommendations of the Hospital Committee on Maternal Mortality, which called for shortening delays and also improving the care of women suffering from abortion complications. This explains why the Gabonese Society of Obstetric Gynecology and Reproduction (GSOGR) have agreed to participate in the FIGO initiative for the prevention of unsafe abortions and their consequences [5]. For example, hospitals have introduced manual intra-uterine aspiration training (MIA) into health care provider. It is a method of uterine evacuation that mobilizes few means, accessible by all health formations and preserves fertility by avoiding immediate complications. It can be made using syringe (SMIA) or electric vacuum cleaner (EMIA). Since then, MIA has been widely used in all health units in Libreville.
The purpose of our study was to describe and analyze the practice of MIA in motherhood of Owendo’s Teaching hospital with a view to contribute to the reduction of maternal morbidity and mortality.

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