Abstract：
BACKGROUND: Abortion-related complications are one of the five main causes of maternal mortality. However, research about abortion is very limited in fragile and conflict-affected settings. Our study aims to describe the magnitude and severity of abortion-related complications in two referral hospitals supported by Médecins Sans Frontières and located in such settings in northern Nigeria and Central African Republic (CAR).
METHODS: We used a methodology similar to the World Health Organization (WHO) near-miss approach adapted in the WHO multi-country study on abortion (WHO-MCS-A). We conducted a cross-sectional study in the two hospitals providing comprehensive emergency obstetric care. We used prospective medical records\' reviews of women presenting with abortion-related complications between November 2019 and July 2021. We used descriptive analysis and categorized complications into four mutually exclusive categories of increasing severity.
RESULTS: We analyzed data from 520 and 548 women respectively in Nigerian and CAR hospitals. Abortion complications represented 4.2% (Nigerian hospital) and 19.9% (CAR hospital) of all pregnancy-related admissions. The severity of abortion complications was high: 103 (19.8%) and 34 (6.2%) women were classified as having severe maternal outcomes (near-miss cases and deaths), 245 (47.1%) and 244 (44.5%) potentially life-threatening, 39 (7.5%) and 93 (17.0%) moderate, and 133 (25.6%) and 177 (32.3%) mild complications, respectively in Nigerian and CAR hospitals. Severe bleeding/hemorrhage was the main type of complication in both settings (71.9% in the Nigerian hospital, 57.8% in the CAR hospital), followed by infection (18.7% in the Nigerian hospital, 27.0% in the CAR hospital). Among the 146 women (Nigerian hospital) and 231 women (CAR hospital) who did not report severe bleeding or hemorrhage before or during admission, anemia was more frequent in the Nigerian hospital (66.7%) compared to the CAR hospital (37.6%).
CONCLUSIONS: Our data suggests high severity of abortion-related complications in these two referral facilities of fragile and conflict-affected settings. Factors that could contribute to this high severity in these contexts include greater delays in accessing post-abortion care, decreased access to contraceptive and safe abortion care that result in increased unsafe abortions; as well as increased food insecurity leading to iron-deficiencies and chronic anaemia. The results highlight the need for better access to safe abortion care, contraception, and high quality postabortion care to prevent and manage complications of abortion in fragile and conflict-affected settings.
METHODS: We used a methodology similar to the World Health Organization (WHO) near-miss approach adapted in the WHO multi-country study on abortion (WHO-MCS-A). We conducted a cross-sectional study in the two hospitals providing comprehensive emergency obstetric care. We used prospective medical records\' reviews of women presenting with abortion-related complications between November 2019 and July 2021. We used descriptive analysis and categorized complications into four mutually exclusive categories of increasing severity.
RESULTS: We analyzed data from 520 and 548 women respectively in Nigerian and CAR hospitals. Abortion complications represented 4.2% (Nigerian hospital) and 19.9% (CAR hospital) of all pregnancy-related admissions. The severity of abortion complications was high: 103 (19.8%) and 34 (6.2%) women were classified as having severe maternal outcomes (near-miss cases and deaths), 245 (47.1%) and 244 (44.5%) potentially life-threatening, 39 (7.5%) and 93 (17.0%) moderate, and 133 (25.6%) and 177 (32.3%) mild complications, respectively in Nigerian and CAR hospitals. Severe bleeding/hemorrhage was the main type of complication in both settings (71.9% in the Nigerian hospital, 57.8% in the CAR hospital), followed by infection (18.7% in the Nigerian hospital, 27.0% in the CAR hospital). Among the 146 women (Nigerian hospital) and 231 women (CAR hospital) who did not report severe bleeding or hemorrhage before or during admission, anemia was more frequent in the Nigerian hospital (66.7%) compared to the CAR hospital (37.6%).
CONCLUSIONS: Our data suggests high severity of abortion-related complications in these two referral facilities of fragile and conflict-affected settings. Factors that could contribute to this high severity in these contexts include greater delays in accessing post-abortion care, decreased access to contraceptive and safe abortion care that result in increased unsafe abortions; as well as increased food insecurity leading to iron-deficiencies and chronic anaemia. The results highlight the need for better access to safe abortion care, contraception, and high quality postabortion care to prevent and manage complications of abortion in fragile and conflict-affected settings.
摘要：
背景：流产相关并发症是孕产妇死亡的五个主要原因之一。然而,在脆弱和受冲突影响的环境中，关于堕胎的研究非常有限。我们的研究旨在描述由无国界医生组织支持的两家转诊医院中堕胎相关并发症的严重程度和严重程度，这些医院位于尼日利亚北部和中非共和国（CAR）。
方法：我们使用的方法类似于世界卫生组织（WHO）在多国堕胎研究（WHO-MCS-A）中采用的方法。我们在提供全面急诊产科护理的两家医院进行了横断面研究。我们使用了2019年11月至2021年7月期间出现堕胎相关并发症的女性的前瞻性医疗记录。我们使用描述性分析，并将并发症分为四个相互排斥的严重程度增加的类别。
结果：我们分别分析了来自尼日利亚和CAR医院的520和548名妇女的数据。堕胎并发症占所有妊娠相关入院的4.2％（尼日利亚医院）和19.9％（CAR医院）。流产并发症的严重程度很高：103名（19.8％）和34名（6.2％）妇女被归类为具有严重的产妇结局（近错过病例和死亡）。245（47.1％）和244（44.5％）可能危及生命，39（7.5%）和93（17.0%）中等，133例（25.6%）和177例（32.3%）轻度并发症，分别在尼日利亚和CAR医院。严重出血/出血是两种情况下的主要并发症类型（尼日利亚医院的71.9%，汽车医院的57.8%)，其次是感染（尼日利亚医院占18.7%，汽车医院的27.0%)。在146名妇女（尼日利亚医院）和231名妇女（CAR医院）中，在入院前或入院期间未报告严重出血或出血，与CAR医院(37.6%)相比,尼日利亚医院的贫血发生率更高(66.7%).
结论：我们的数据表明，在这两个脆弱和受冲突影响的转诊机构中，堕胎相关并发症的严重程度很高。在这些情况下可能导致这种严重程度的因素包括获得堕胎后护理的更大延误，获得避孕药具和安全堕胎护理的机会减少，导致不安全堕胎增加；以及粮食不安全增加，导致缺铁和慢性贫血。结果强调需要更好地获得安全的堕胎护理，避孕,以及高质量的堕胎后护理，以预防和管理脆弱和受冲突影响环境中的堕胎并发症。
方法：我们使用的方法类似于世界卫生组织（WHO）在多国堕胎研究（WHO-MCS-A）中采用的方法。我们在提供全面急诊产科护理的两家医院进行了横断面研究。我们使用了2019年11月至2021年7月期间出现堕胎相关并发症的女性的前瞻性医疗记录。我们使用描述性分析，并将并发症分为四个相互排斥的严重程度增加的类别。
结果：我们分别分析了来自尼日利亚和CAR医院的520和548名妇女的数据。堕胎并发症占所有妊娠相关入院的4.2％（尼日利亚医院）和19.9％（CAR医院）。流产并发症的严重程度很高：103名（19.8％）和34名（6.2％）妇女被归类为具有严重的产妇结局（近错过病例和死亡）。245（47.1％）和244（44.5％）可能危及生命，39（7.5%）和93（17.0%）中等，133例（25.6%）和177例（32.3%）轻度并发症，分别在尼日利亚和CAR医院。严重出血/出血是两种情况下的主要并发症类型（尼日利亚医院的71.9%，汽车医院的57.8%)，其次是感染（尼日利亚医院占18.7%，汽车医院的27.0%)。在146名妇女（尼日利亚医院）和231名妇女（CAR医院）中，在入院前或入院期间未报告严重出血或出血，与CAR医院(37.6%)相比,尼日利亚医院的贫血发生率更高(66.7%).
结论：我们的数据表明，在这两个脆弱和受冲突影响的转诊机构中，堕胎相关并发症的严重程度很高。在这些情况下可能导致这种严重程度的因素包括获得堕胎后护理的更大延误，获得避孕药具和安全堕胎护理的机会减少，导致不安全堕胎增加；以及粮食不安全增加，导致缺铁和慢性贫血。结果强调需要更好地获得安全的堕胎护理，避孕,以及高质量的堕胎后护理，以预防和管理脆弱和受冲突影响环境中的堕胎并发症。
