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Preventing death following unsafe abortion: a case series from urban Uganda

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Background: Maternal deaths from unsafe abortion continue to occur globally, with particularly high rates in Sub-Saharan Africa where the majority of abortions are classified as unsafe. Maternal death reviews have been shown to be an effective part of cohesive strategies to prevent future deaths while abortion remains illegal.

Objectives: To conduct maternal death reviews for all deaths occurring following unsafe abortion during the study period. To assess preventability and to synthesise key learning points that may help to prevent future maternal deaths following unsafe abortions.

Study design: Full case reviews of all maternal deaths (n=350, Jan 2016 - Dec 2018) at the study center (a national referral hospital in urban Uganda) were conducted by specially trained multidisciplinary panels of obstetricians and midwives. We extracted the reviews of women who died following unsafe abortions (n=13, 2.6%) for further analysis.

Results: The majority of maternal deaths due to unsafe abortion were found to be preventable. The key recommendations that emerged from the reviews were: (i) that clinicians should maintain a high index of suspicion for delayed presentation and rapid decompensation in cases where unsafe abortion has occurred, (ii) that a low threshold for early intravenous antibiotic therapy should be applied, and (iii) that any admission with complications following an unsafe abortion merits review by an experienced clinician as soon as practicable.

Conclusions: Post-abortion care is part of essential emergency medical care and should be provided to high standards, especially in areas where there is limited or no legal access to abortion care. Implementing the recommended learning points is likely to be feasible even in low resource obstetric settings and, given the high rates of preventability found in maternal deaths due to unsafe abortion, is likely to be effective.


Funder: Government of the United Kingdom


maternal death, postabortion care, sepsis, unsafe abortion, uterine perforation

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AJOG Global Reports

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Wellcome Trust (07742/Z/15/Z)
African Academy of Sciences (DEL15-011)
This work was supported through the DELTAS Africa programme grant # DEL15-011. The DELTAS Africa programme is an independent funding scheme of The African Academy of Sciences (The AAS) supported by Wellcome 07742/Z/15/Z and the UK government. At The AAS, DELTAS Africa is implemented through AESA (Accelerating Excellence in Science in Africa), the Academy’s agenda and programmatic platform, created in collaboration with the African Union (AUDA-NEPAD) Agency. The views expressed in this publication are those of the author(s) and not necessarily those of The AAS, the AUDA-NEPAD Agency, Wellcome or the UK government. The funders had no role in in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.