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CC BY 4.0 · Rev Bras Ginecol Obstet 2021; 43(07): 507-512
DOI: 10.1055/s-0041-1735129
Original Article | Original Article
Obstetrics

Factors Associated with Abortion Complications after the Implementation of a Surveillance Network (MUSA Network) in a University Hospital

Fatores associados a complicações do aborto após a implementação de um sistema de vigilância (Rede MUSA) em um hospital universitário
Camila Ayume Amano Cavalari 
1   Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas – UNICAMP – Brazil
,
Nelio Neves Veiga-Junior 
1   Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas – UNICAMP – Brazil
,
Beatriz Deguti Kajiura 
1   Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas – UNICAMP – Brazil
,
Caroline Eugeni 
1   Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas – UNICAMP – Brazil
,
Barbara Virgínia Gonçalves Tavares 
1   Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas – UNICAMP – Brazil
,
Luiz Francisco Baccaro 
1   Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas – UNICAMP – Brazil
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Abstract

Objective To evaluate the factors associated with abortion complications following the implementation of the good-practice surveillance network Mujeres en Situación de Aborto (Women Undergoing Abortion, MUSA, in Spanish).

Methods A cross-sectional study with women who underwent abortion due to any cause and in any age group at UNICAMP Women's Hospital (part of MUSA network), Campinas, Brazil, between July 2017 and Agust 2019. The dependent variable was the presence of any abortion-related complications during hospitalization. The independent variables were clinical and sociodemographic data. The Chi-square test, the Mann–Whitney test, and multiple logistic regression were used for the statistical analysis.

Results Overall, 305 women were enrolled (mean ± standard deviation [SD] for age: 29.79 ± 7.54 years). The mean gestational age was 11.17 (±3.63) weeks. Accidental pregnancy occurred in 196 (64.5%) cases, 91 (29.8%) due to contraception failure. At least 1 complication was observed in 23 (7.54%) women, and 8 (34.8%) of them had more than 1. The most frequent complications were excessive bleeding and infection. The factors independently associated with a higher prevalence of complications were higher gestational ages (odds ratio [OR]: 1.22; 95% confidence interval [95%CI]: 1.09 to 1.37) and contraceptive failure (OR: 3.4; 95%CI: 1.32 to 8.71).

Conclusion Higher gestational age and contraceptive failure were associated with a higher prevalence of complications. This information obtained through the surveillance network can be used to improve care, particularly in women more susceptible to unfavorable outcomes.

Resumo

Objetivo Avaliar os fatores associados às complicações em casos de aborto após a implementação da rede de vigilância de boas práticas Mujeres en Situación de Aborto (Mulheres em Situação de Aborto, MUSA, em espanhol).

Métodos Um estudo transversal, com mulheres admitidas por aborto de qualquer causa e em qualquer faixa etária, no Hospital da Mulher da UNICAMP (parte da rede MUSA), Campinas, Brasil, entre julho de 2017 e agosto de 2019. A variável dependente foi a presença de qualquer complicação relacionada ao quadro de aborto durante a hospitalização. As variáveis independentes foram dados clínicos e sociodemográficos. O teste de qui-quadrado, o teste de Mann-Whitney, e a regressão logística múltipla foram usados na análise estatística.

Resultados Foram incluídas 305 mulheres (média ± desvio padrão [DP] da idade: 29,79 ± 7,54 anos). A idade gestacional média foi de 11,17 (±3,63) semanas. A gravidez não foi planejada em 196 (64,5%) casos, 91 (29,8%) devido a falha de contraceptivo. Pelo menos 1 complicação foi observada em 23 (7,64%) mulheres, 8 (34,8%) das quais apresentaram mais de uma complicação. As complicações mais frequentes foram sangramento excessivo e infecção. Os fatores independentemente associados à maior prevalência de complicações foram idades gestacionais maiores (razão de chances [OR]: 1.22; intervalo de confiança de 95% [IC95%]: 1.09 a 1.37) e falha de contraceptivo (OR: 3.4; IC95%: 1.32 a 8.71).

Conclusão Maior idade gestacional e falha de contraceptivo estiveram associados à maior prevalência de complicações. As informações obtidas pela rede de vigilância podem ser usadas para melhorar o cuidado, particularmente nas mulheres mais suscetíveis a desfechos desfavoráveis.

Keywords

CLAP MUSA network - perinatal information system - population surveillance - abortion - EviSIP

Palavras-chave

rede CLAP MUSA - sistema de informação perinatal - vigilância populacional - aborto - EviSIP

Contributions

CAAC contributed to project development, data collection, study conception and design, and wrote the manuscript. NNVJ, CE, BVGT, BDK, LFCB contributed to project development, data collection, and study conception and design. All authors reviewed and approved the final manuscript.




Publication History

Received: 21 November 2020

Accepted: 21 July 2021

Article published online:
30 August 2021

© 2021. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Prendeville W. Epidemiology of miscarriage. In: Grudzinskas JG, O'Brien PM. editors. Problems in early pregnancy: advances in diagnosis and management. London: RCOG Press; 1997: 1-15
    Search in Google Scholar
  • 2 Bearak J, Popinchalk A, Ganatra B. et al. Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990-2019. Lancet Glob Health 2020; 8 (09) e1152-e1161
    CrossrefPubMedSearch in Google Scholar
  • 3 Singh S, Maddow-Zimet I. Facility-based treatment for medical complications resulting from unsafe pregnancy termination in the developing world, 2012: a review of evidence from 26 countries. BJOG 2016; 123 (09) 1489-1498
    CrossrefPubMedSearch in Google Scholar
  • 4 Say L, Chou D, Gemmill A. et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014; 2 (06) e323-e333
    CrossrefPubMedSearch in Google Scholar
  • 5 Domingues RMSM, Fonseca SC, Leal MDC, Aquino EML, Menezes GMS. Unsafe abortion in Brazil: a systematic review of the scientific production, 2008-2018. Cad Saude Publica 2020; 36 (36, Suppl 1) e00190418
    CrossrefPubMedSearch in Google Scholar
  • 6 Santana DS, Cecatti JG, Parpinelli MA. et al; Brazilian Network for Surveillance of Severe Maternal Morbidity. Severe maternal morbidity due to abortion prospectively identified in a surveillance network in Brazil. Int J Gynaecol Obstet 2012; 119 (01) 44-48
    CrossrefPubMedSearch in Google Scholar
  • 7 Adinma E. Unsafe abortion and its ethical, sexual and reproductive rights implications. West Afr J Med 2011; 30 (04) 245-249
    PubMedSearch in Google Scholar
  • 8 Veiga-Junior NN, Cavalari CA, Eugeni C, Kajiura BD, Stefano N, Baccaro LF. Post-abortion contraception before hospital discharge after installation of a surveillance network in Brazil. Int J Gynaecol Obstet 2020; 150 (02) 200-205
    CrossrefPubMedSearch in Google Scholar
  • 9 Serruya SJ, Gómez Ponce de León R, Bahamondes MV. et al. EviSIP: using evidence to change practice through mentorship - an innovative experience for reproductive health in the Latin American and Caribbean regions. Glob Health Action 2020; 13 (01) 1811482
    CrossrefPubMedSearch in Google Scholar
  • 10 Tabachnick BG, Fidell LS. Using multivariate statistics. 5th ed.. Boston: Pearson/Allyn and Bacon; 2007
    Search in Google Scholar
  • 11 Upadhyay UD, Desai S, Zlidar V. et al. Incidence of emergency department visits and complications after abortion. Obstet Gynecol 2015; 125 (01) 175-183
    CrossrefPubMedSearch in Google Scholar
  • 12 Kerns J, Steinauer J. Management of postabortion hemorrhage: release date November 2012 SFP Guideline #20131. Contraception 2013; 87 (03) 331-342
    CrossrefPubMedSearch in Google Scholar
  • 13 Newmann S, Dalve-Endres A, Drey EA. Society of Family Planning. Clinical guidelines. Cervical preparation for surgical abortion from 20 to 24 weeks' gestation. Contraception 2008; 77 (04) 308-314
    CrossrefPubMedSearch in Google Scholar
  • 14 De La Vega GA, Nemiroff R, Debbs R. Complications of second-trimester dilation and evacuation. Obstet Gynecol 2007; 109 (Suppl. 04) 21S
    PubMedSearch in Google Scholar
  • 15 Allanson B, Jennings B, Jacques A, Charles AK, Keil AD, Dickinson JE. Infection and fetal loss in the mid-second trimester of pregnancy. Aust N Z J Obstet Gynaecol 2010; 50 (03) 221-225
    CrossrefPubMedSearch in Google Scholar
  • 16 United Nations. Department of Economic and Social Affairs. Population Division. Contraceptive use by method 2019: Data Booklet (ST/ESA/SER.A/435). New York: UN; 2019
    Search in Google Scholar
  • 17 Ali M, Folz R, Farron M. Expanding choice and access in contraception: an assessment of intrauterine contraception policies in low and middle-income countries. BMC Public Health 2019; 19 (01) 1707
    CrossrefPubMedSearch in Google Scholar
  • 18 United Nations. Department of Economic and Social Affairs. Population Division. Trends in contraceptive use worldwide 2015. New York: UN; 2016
    Search in Google Scholar
  • 19 Constant D, Kluge J, Harries J, Grossman D. An analysis of delays among women accessing second-trimester abortion in the public sector in South Africa. Contraception 2019; 100 (03) 209-213
    CrossrefPubMedSearch in Google Scholar
  • 20 Mizana BA, Woyecha T, Abdu S. Delay in decision and determinants for safe abortion among women at health facilities in south West Ethiopia: facility based cross sectional study. Int J Equity Health 2020; 19 (01) 7
    CrossrefPubMedSearch in Google Scholar
  • 21 Araújo TVB, Aquino EML, Menezes GMS. et al. Delays in access to care for abortion-related complications: the experience of women in Northeast Brazil. Cad Saude Publica 2018; 34 (06) e00168116
    CrossrefPubMedSearch in Google Scholar
  • 22 Ireland LD, Gatter M, Chen AY. Medical compared with surgical abortion for effective pregnancy termination in the first trimester. Obstet Gynecol 2015; 126 (01) 22-28
    CrossrefPubMedSearch in Google Scholar
  • 23 Fonseca SC, Domingues RMSM, Leal MDC, Aquino EML, Menezes GMS. Legal abortion in Brazil: systematic review of the scientific production, 2008-2018. Cad Saude Publica 2020; 36 (36, Suppl 1) e00189718
    CrossrefPubMedSearch in Google Scholar
  • 24 Briozzo L, Gómez Ponce de León R, Tomasso G, Faúndes A. Overall and abortion-related maternal mortality rates in Uruguay over the past 25 years and their association with policies and actions aimed at protecting women's rights. Int J Gynaecol Obstet 2016; 134 (S1): S20-S23
    CrossrefPubMedSearch in Google Scholar
  • 25 Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group. United Nations Population Division. Geneva: WHO; 2019
    Search in Google Scholar