Background: Abortion-related sepsis contributes significantly to reproductive morbidity and preventable mortality in Nigeria. Effective strategies to combat the associated Severe Maternal Outcomes (SMO) requires reliable statistics and an understanding of the immediate contributors.
Methods: A retrospective review of women managed for abortion-related sepsis between September, 2006 and August, 2015 at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria. The socio-demographic characteristics, pattern of presentation, reasons for termination of pregnancy and clinical outcomes were analysed. Life-threatening complication rate, mortality index and maternal mortality ratio were determined using the WHO "Near-Miss" concept.
Results: Overall, 128 women were managed for abortion-related sepsis, with 11,565 live births within the decade. Eighty (79.6%) of the 88 women with induced abortions were not on contraception, though pregnancy was not desired. Interference with education, paternity dispute and short inter-pregnancy interval were the commonest reasons for pregnancy termination. Near-misses were recorded in 67.5% of the women, especially anaemia requiring at least 4units of blood and laparotomy for non-caesarean indications. The mortality-index and case fatality rate were 13.9% and 9.4% respectively, predominantly due to multiple organ dysfunction from overwhelming sepsis.
Conclusion: The life-threatening complication rate and mortality index associated with abortion-related sepsis at the OAUTHC remain bothersome, with a 1:7.5 chance of mortality once diagnosed. The maternal near-misses identified in this study would serve as alert signals to Physicians on the risk of maternal death in these women. Strategies should be implemented to facilitate access to contraception, standardised abortion-related services and hospital-based interventions to care for maternal near-misses.
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