Management of incomplete abortions at South African public hospitals

Fawcus, S. ; McIntyre, J. ; Jewkes, R. K. ; Rees, H. ; Katzenellenbogen, J. M. ; Shabodien, R. ; Lombard, C. J. ; Truter, H. ; Cronje, H. ; Duminy, P. ; Marivate, M. ; Moodley, J. ; Pattinson, B. (1997)


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Objective. The objective of this report was to review and describe the management of incomplete abortion by public sector hospitals. Design. A descriptive study in which data were collected prospectively from routine hospital records on all women admitted with incomplete abortion to a stratified random sample of hospitals between 14 and 28 September 1994. Setting. Public sector hospitals in South Africa. Patients. Women with incomplete abortions. Main outcome measures. Length of hospital stay, details of medical management, details of surgical management, determinants of the above. Main results. Data were collected on 803 patients from the 56 participating hospitals. Of these, 767 (95.9%) were in hospital for 1 day or more, and 753 (95.3%) women underwent evacuation of the uterus. Sharp curettage was the method employed in 726 (96.9%) and general anaesthesia was used for 601 (88%) of the women requiring uterine evacuation. Antibiotics were prescribed for 396 (49.5%) and blood transfusions were administered to 125 (17%) women. Statistical analysis showed length of stay to be longer in small hospitals (under 500 beds) and when the medical condition was more severe. Antibiotic usage and blood transfusion were more common with increasing severity and a low haemoglobin level on admission. However, some inappropriate management was identified with regard to both. Main conclusions. It is suggested that uncomplicated incomplete abortion can be more effectively and safely managed using the manual vacuum aspiration technique with sedation/analgesia as an outpatient procedure. Attention should be directed at the introduction of this management routine at all types of hospital and to the ensuring of appropriate management of women with complicated abortion.

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