Management of abortion at a rural hospital in Uganda – a quality assesment by a criterion based audit

Description

Abstract:

Objective:
By a criterion-based audit to assess the management of abortion-complications at a rural hospital in Uganda.
Methods and materials:
Audit criteria of realistic best management according to international guidelines were formulated. 228 retrospective and 10 prospective cases admitted with abortion-complications were included and assessed by the criteria:
I. Measurements of vitals
II. Fluid resuscitation to patients with a systolic blood pressure ≤ 90 mmHg.
III. Use of Broad-spectrum antibiotics.
IV. Type of evacuation-procedure compared to gestational age. V. Pain management. Further it was investigated whether it increases the risk of a longer hospital stay if the criteria not were met.
Results:
54.4% were second trimester abortions. Cases aged above mean had significantly reduced risk for second trimester abortion compared to age below mean. Cases aged below mean had significantly increased risk of second trimester abortion compared to first trimester abortion.
Only 8 cases had all vitals measured. 24 cases with indication for fluid resuscitation did not receive it. 78 cases without indication got antibiotics and 5 cases with did not. 21 first trimester abortions were treated with dilatation and curettage instead of MVA. 24 cases in pain did not receive analgesia. Incomplete abortion managed with misoprostol had a significantly longer stay. Lack of antibiotics to threatened abortion was significantly associated with a shorter stay than average. No other associations with length of stay were found.
Conclusion:
In the majority of cases substandard management was present. Improvements can be made and use of guidelines for management must be strengthened.