Les avortements clandestins au Centre Hospitalier Universitaire de Libreville de 2014 à 2018 : à propos de 212 cas
2021
Objectif : Cette etude avait pour but d’etudier les aspects epidemiologiques cliniques et therapeutiques des avortements clandestins dans le service de gynecologie interne du Centre Hospitalier Universitaire de Libreville de 2014 en 2018.
Patients et methodes : Il s’est agi d’une etude retrospective, descriptive qui s’est deroulee du 1er janvier au 31 decembre 2018. Elle a porte sur toutes les patientes ayant pratiquees un avortement clandestin avec un âge gestationnel inferieur ou superieur a 12 semaines amenorrhee, mariees ou celibataires, admises et/ou prise en charge dans le service de gynecologique interne du CHUL, dans la periode de l’etude quelle que soit leur provenance. L’approche de collecte etait une enquete par depouillement de dossiers medicaux assortie a une etude des registres de compte rendu d’hospitalisation.
Resultats : La frequence moyenne annuelle des avortements provoques etait de 50±3,1 avortements pour 1000 accouchements. Cette frequence a ete multipliee par 5 en 2014 et 2018. L’âge moyen etait de 27,3± 6,6 ans avec des extremes de 14 et 50ans. La majorite, soit 62,3% etait du niveau secondaire, 79,9% etait celibataires. L’âge gestationnel etait connu pour 60,4% et inferieur a 12 semaines d’amenorrhee dans 46,7% des cas. Deux ethnies etaient majoritairement representees : les fangs 32,1% et les punus 25,5%. Le lieu de l’avortement etait principalement le domicile familial pour 72,6% des patientes. La methode abortive utilisee etait principalement le comprime de misoprostol a 58,0%. Le motif de l’avortement etait a 52,8% une grossesse non desiree plus ou moins associee a 22,6% a un manque de moyens financiers. Sur le plan clinique, le diagnostic retenu etait principalement l’avortement complique d’une hemorragie (55,6%). La prise en charge comprenait : le remplissage vasculaire (59,0%), l’AMIU (50,9%), l’antibiotherapie (88,6%) domine par le metronidazole a 53,3%, la transfusion (60,8%), le fer et les acides foliques (35,4%), uterotonique (34,0%). La complication majeure etait l’anemie (71,7%). L’evolution etait favorable pour 92,5% dont 75% (soit 16/212) sont decedes en cours d’hospitalisation.
Conclusion : L’avortement clandestin demeure un probleme de sante publique dans notre pays, de par sa frequence croissante, et ses omplications a type d’hemorragie pouvant engager le pronostic vital. La technique d’Aspiration Manuelle Intra uterine (AMIU) a encore montre son efficacite dans la prise en charge des complications de cette pratique avant l’âge gestationnel de 12 semaines d’amenorrhee. Sensibiliser davantage les populations sur les methodes contraceptives et elargir sur le plan juridique l’acces a l’avortement medicalise au premier trimestre de grossesse, pourraient amoindrir l’incidence et les complications de ces avortements dans notre region.
Mots cles : Epidemiologie, clinique, therapeutique, avortement clandestin, Libreville
English Abstarct:
Clandestine abortions at the Libreville University Hospital Center from 2014 to 2018: About 212 cases
Objective: The aim of this study was to investigate the clinical and therapeutic epidemiological aspects of clandestine abortions in the internal gynecology department of the University Hospital of Libreville from 2014 to 2018.
Patients and methods: This was a retrospective, descriptive study that took place from January 1 to December 31, 2018. It focused on all patients who had performed a clandestine abortion with a gestational age of less than or greater than 12 weeks of amenorrhea, married or single, admitted and/or managed in the internal gynecological service of the CHUL, in the period of the study regardless of their origin. The collection approach was a medical record survey combined with a study of hospitalization records.
Results: The average annual frequency of induced abortions was 50±3.1 abortions per 1000 deliveries. This frequency increased 5-fold in 2014 and 2018. The average age was 27.3± 6.6 years extreme 14 and 50 years. The majority, 62.3% were of secondary school level, 79.9% were single. Gestational age was known for 60.4% and less than 12 weeks of amenorrhea in 46.7% of cases. Two ethnic groups were predominantly represented: the Fangs (32.1%) and the Punus (25.5%). The place of abortion was mainly the family home for 72.6% of patients. The abortion method used was mainly misoprostol tablets (58.0%). The reason for the abortion was an unwanted pregnancy in 52.8% of cases, more or less associated with a lack of financial means in 22.6%. Clinically, the diagnosis was mainly abortion complicated by hemorrhage (55.6%). Management included: vascular filling (59.0%), MVA (50.9%), antibiotic therapy (88.6%) dominated by metronidazole (53.3%), transfusion (60.8%), iron and folic acids (35.4%), uterotonic (34.0%). The major complication was anemia (71.7%). The evolution was favorable for 92.5% of which 75% (16/212) died during hospitalization.
Conclusion: Clandestine abortion remains a public health problem in our country, due to its increasing frequency, and its complications such as hemorrhage that can be life threatening. The IMIU technique has again shown its effectiveness in the management of complications of this practice before the gestational age of 12 weeks of amenorrhea. Increased awareness of contraceptive methods and legal access to medical abortion in the first trimester of pregnancy could reduce the incidence and complications of these abortions in our religion.
Keywords: Epidemiology, clinical, therapeutic, clandestine abortion, Libreville.
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