Ulysse Minkobame, Sosthène Mayi-Tsonga, Pamphile A Obiang, Opheelia M Komba, Justine M Ella, Jean F Meye, Aníbal Faúndes
International Journal of Gynecology & Obstetrics 2018;1–2. DOI: 10.1002/ijgo.12586 (Not open access)
Maternal mortality has been monitored at the Centre Hospitalier de Libreville (CHL), Gabon, since 2005. A study conducted in 2008 found that abortion-related maternal mortality was responsible for 25% of maternal deaths between 2005 and 2007. Furthermore, substantial delays in provision of care were extremely common among women who died from abortion-related causes, with an average delay of 23.4 hours compared with around 1 hour among women who died from eclampsia or haemorrhage. The immediate reaction to these findings was to take actions to reduce these delays by introduction of manual vacuum aspiration (MVA) and through training of midwives and residents to perform the technique. Subsequent evaluation conducted in 2012 showed that the average delay in provision of care to women admitted for abortion had fallen from a mean of 18 hours before 2008 to 1.8 hours in the 5-month period between November 1, 2011, and March 31, 2012. In 2013, a new hospital administration limited midwives participation in treatment of abortion and failed to address the delays in provision of care. Thereafter, physicians prioritized obstetric patients and abortion patients were left behind, as was the case before 2007.
In this article, we describe the results of changes in abortion-related fatalities in CHL over four consecutive 3-year periods: 2005-07, 2008-10, 2011-13, and 2014-16. The outcome evaluated was the number of abortion-related deaths per 1000 women and the proportion of all maternal deaths caused by abortion. Analysis was based on retrospective evaluation of clinical records without identification of patients; thus, informed consent was not requested. This study was approved by the administration of CHL acting as the ethical review committee. No statistical analysis was done. The abortion-related fatality rate fell from 12.3 per 1000 abortions between 2005 and 2007, to 2.9 per 1000 in 2008–10, and 0.7 per 1000 in 2011–13 (Table 1). Abortion-related maternal deaths accounted for 25% of all maternal deaths in the first period, with this percentage decreasing to 10% in the second period and to 2% in the third period. After the changes in hospital administration, the abortion-related fatality rate increased to 10 per 1000 abortions and to 14% of all maternal deaths between 2014 and 2016. Our findings suggest that abortion-related mortality can be substantially reduced by interventions within the hospital aimed at improving the care of women with abortion-related complications, particularly by reducing delays in the provision of effective care. These findings also highlight the importance of constantly motivating hospital staff to ensure that this beneficial effect remains.