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International Journal of Statistical Sciences ISSN 1683-5603
Vol. 18, 2019, pp 77-86
© 2019 Dept. of Statistics, Univ. of Rajshahi, Bangladesh
Incomplete Abortion and Associated Risk Factors of the
Patients Admitted in Rajshahi Medical College Hospital,
Rajshahi, Bangladesh
Md. Abdul Awal*1, Jarin Sazzad2, Farida Khatun2, Md. Jawadul
Haque2 and Md. Golam Hossain3
1
Department of Public Health, Varendra University,
Rajshahi-6204, Bangladesh
2
Rajshahi Medical College, Rajshahi-6000, Bangladesh
3
Health Research Group, Department of Statistics, University of Rajshahi,
Rajshahi-6205, Bangladesh
*Correspondence should be addressed to Md. Abdul Awal
(limonawal@gmail.com)
[Received April 3, 2019; Revised August 5, 2019; Accepted November 13, 2019]
Abstract
This cross sectional type of descriptive study was carried out with a view to find out the
situation of incomplete abortion and associated risk factors of the patients admitted in
Rajshahi Medical College Hospital. The sample size was 150 which were selected
purposively. This study showed that 37.3% of the respondents were in the age group of
25-29 years. The mean age of the respondents was 25.14 ± 4.95 years. Majority (75.3%)
had history of contraceptive use. It was observed that 30.0% had hemoglobin level of 15
gm/dl followed by 22.7% and 20.0% constituting hemoglobin level of 14 gm/dl and 13
gm/dl respectively. Most (67.3%) respondents had history of previous history of abortion
and 65.3% of the respondents had chronic vaginal bleeding. Uses of oral contraceptive
pill, history of previous abortion were found the associated risk factors of abortion in this
study. Intensifying reproductive health education would assist in the reduction of
complications of abortions.
Key words:
Abortion, contraceptive, reproductive health.
AMS Classification:
92C50.
78 International Journal of Statisticsl Sciences, Vol. 18, 2019
1. Introduction
An incomplete abortion is an abortion that has only been partially successful. The
pregnancy has ended – no fetus will develop, but body has only expelled part of
the tissue and products of pregnancy (Women waves, 2014). A total of 266
women seeking care at health facilities for the treatment of incomplete abortion in
Tigrau, Ethiopia were studied, and factors associated with severe complications
related to unsafe abortion were assessed. Women had significantly higher odds of
experiencing severe clinical complications if they were married compared with
unmarried (odds ratio 3.98; 95% confidence interval, 1.75-9.04) or were seen in a
mid–or low-level health facility (a health center or health post) compared with a
high-level facility (a hospital) (odds ratio 4.77; 95% confidence interval, 1.87-
12.19). Safe abortion services by mid-level providers so that pregnancy
termination no longer means placing women’s lives and health in danger (Gerdts,
C., et.al. 2012).A cross-sectional, descriptive study was conducted in Department
of Obstetrics and Gynaecology, Unit 3, Dow Medical College and Civil Hospital
Karachi. The frequency of unsafe abortion was 1.35% and the case fatality rate
was 34.9%. A complete family was the main reason for induced abortion (14/29;
48.2%) followed by being unmarried (8/29, 27.5%) and domestic violence in 5/29
cases (17.2%). The high maternal mortality and morbidity of unsafe abortion in a
study highlights the need for improving contraceptive and safe abortion services
in Pakistan (Shah, N., et.al. 2011).Romania improved contraceptive policies and
services, and Bangladesh made advances in emergency obstetric care and family
planning (Rachootin, P., et.al. 1982).Unsafe abortion and inadequate post-abortion
care are significant contributors to maternal mortality, which is a major cause of
death among women of reproductive age worldwide (Bhutta, S,. et.al. 2003). In
both India and Zambia, abortion was legalized in the early 1970’s, but due to a
lack of adequate services and continued procedural barriers, safe abortions remain
limited. However, due to required consent from three registered medical
practitioners and a lack of available safe abortion services, many women continue
to rely on unsafe, clandestine abortions, which contribute to the maternal mortality
ratio, currently at 591 deaths per 100,000 live births. Only recently has the
Zambian government made a commitment to address barriers to safe abortion
Awal, Sazzad, Khatun, Haque and Hossain:
Incomplete Abortion ... 79
services (Janie, B., et.al. 2011).Access to legal menstrual regulation services is
poorer in rural areas than in urban areas. As a result, in both urban and rural areas,
a substantial proportion of women are believed to obtain abortions from
traditional midwives or attempt to perform the abortion themselves. The maternal
mortality ratio is estimated to be much higher in Bangladesh (480 maternal deaths
per 100,000 births) than in the Philippines (100 per 100,000). A survey of health
workers in Bangladesh in the late 1970s indicated that as many as 26% of
maternal death were due to abortion; Philippine government statistics indicate that
about 10% of recorded maternal deaths were classified as due to abortion
(Susheela, S., et.al. 1997). Illegal abortion deaths are disproportionately due to
infection. In a 1994 US review, 62% of illegal abortion deaths and 51% of
spontaneous abortion deaths were from infection, whereas only 21% of legal
abortion deaths were from infection. Risk of death from post abortion sepsis is
greatest for younger women and unmarried women, and it is more likely with
procedures that do not directly evacuate the uterine content (Wikipedia, 2014).A
report from WHO showed a decline in maternal mortality worldwide from
546,000 deaths in 1990 to 358,000 in 2008, and a parallel decline in death from
unsafe abortion from 69,000 to 47,000 over the same interval. The actual number
of unsafe abortions worldwide increased from 19.7 million in 2003 to 21.6 million
in 2008 because of the growth of the population of women of childbearing age
(Glowm, 2014).Unsafe abortion causes approximately 47,000 maternal deaths and
high levels of morbidity every year. In settings where abortion is legally restricted
or access to safe services is limited, women with unwanted pregnancies often
resort to unsafe abortions and subsequently require urgent medical attention to
treat incomplete abortions or severe complications such as bleeding or infection
(Pacconsortium, 2014).Contraceptive usage is generally low and cultural and
traditional factors may play a role, but expanded sex education programmes and
continued contraceptive counseling need reinforcing before attempts are made to
review the legal issues regarding termination (Mahomed, K., et.al.
1992).Advancing maternal and paternal age are known to be associated with
increasing chance of miscarriage. Other risk factors include being underweight or
overweight, smoking and high alcohol consumption (Oliver, A., et.al. 2014).It was
80 International Journal of Statisticsl Sciences, Vol. 18, 2019
also found that marked geographical inequities as women living in the poorest
states have a higher risk of having an unsafe abortion (Sousa, A., et.al.
2010).Motivations to exclude a parent were often based on particular family
circumstances or experiences that suggested that involvement would not be
helpful, might be harmful, or might restrict a minor’s ability to obtain an abortion
(Hasselbacher, L., et.al. 2014). The complications of unsafe, illegal abortions are a
significant cause of maternal mortality in Botswana (Smith, 2013).While
improved contraceptive use can help reduce unintended pregnancy and abortion,
some abortions will remain difficult to prevent, because of limits to women’s
ability to determine and control all circumstances of their lives (Akiinrinola, A.,
et.al. 1998; Lukman, H., et.al. 1996).The aim of the present study was to
investigate on incomplete abortion and determine associated risk factors of the
patients admitted in Rajshahi medical college hospital.
2. Materials and Methods
This cross sectional type of descriptive study was carried out in the gynae and
obstetrics wards of Rajshahi Medical College Hospital, Rajshahi. Sample size was
150 and that was selected purposively. Data were collected (March to December
2018) from all the patients with history of incomplete abortion from admitted in
Gynae and Obstetric wards of Rajshahi Medical College Hospital, Rajshahi,
according to a duly pre-tested and partially structured questionnaire by face-to-
face interview with the help of a key informant. Dependent variable considered in
this study is incomplete abortion. We considered as independent variables were
age, education, occupation, monthly family income, residence, family type,
history of contraceptive use, blood group and haemoglobin level. The data were
analyzed according to the objectives of the study by using SPSS/PC+ software
computer programme. Descriptive variables were explained with mean and
standard deviation. Hemoglobin, or Hb, is usually expressed in grams per deciliter
(g/dL) of blood. A low level of hemoglobin in the blood relates directly to a
low level of oxygen.
Awal, Sazzad, Khatun, Haque and Hossain:
Incomplete Abortion ... 81
3. Results
Table 1: Distribution of the respondents according to socio-demographic
variables (n=150).
Variables Respondents Variables Respondents
No. % No. %
Age of the respondents:
Less than 20 years
20-24 years
25-29 years
30-34 years
More than 34 years
X ± SD = 25.14 ± 4.95years
History of contraceptive use:
Yes
No
Symptoms
Vaginal bleeding
Abdominal distension
Abdominal pain
Multiple
Sign
Vaginal bleeding
Enlarged
Multiple
26
42
56
17
9
113
37
114
3
7
26
140
4
6
17.3
28.0
37.3
11.3
6.0
75.3
24.7
76.0
2.0
4.7
17.3
93.3
2.7
4.0
Haemoglobin level gm/dL:
11
12
13
14
15
16
20
Monthly family income
Up to Taka 10,000
Taka 10,001-20,000
More than Taka 20,000
X ± SD = Tk. 7607.00 ±
5190.64
Histopathological analysis
Yes
No
Do not know
5
14
30
34
45
21
1
131
16
3
2
31
15
3.3
9.3
20.0
22.7
30.0
14.0
0.7
87.3
10.7
2.0
1.3
20.7
10.0
82 International Journal of Statisticsl Sciences, Vol. 18, 2019
Table 2: Distribution of the respondents according to incomplete abortion and
socio-demographic variables (n=150).
Variables Respondents Variables Respondents
No. % No. %
History of previous abortion:
Yes
NO
Complications of incomplete
abortion
Chronic vaginal bleeding
Foul smelling vaginal discharge
Fever and abdominal pain
Multiple
Treatment for placenta
related disease
Yes
No
91
59
98
2
12
38
147
3
67.3
39.3
65.3
1.3
8.0
25.3
98.0
2.0
Occupation:
Service
Farmer
Day labour
Business
Housewife
Students
History of uterine
evacuation following
abortion
Yes
No
26
3
6
11
103
1
48
102
17.3
2.0
4.0
7.3
68.7
0.7
32.0
68.0
Table 3: Relationship between age group of the respondents and sign-syndrome
of the respondents (n=150).
Age
group of the
respondents
Sign-syndrome of abortion
Lower
abdominal
pain
Per vaginal
bleeding
Expulsion of
product of
conception
Don’t
know
Total
< 20 years 6
(23.1%)
16
(61.5%)
0 (0.0%) 4
(15.4%)
26
(17.3%)
20-24 years 37
(72.5%)
14
(27.5%)
0 (0.0%) 0 (0.0%) 51
(34.0%)
25-29 years 31
(63.3%)
15
(30.6%)
3 (6.1%) 0 (0.0%) 49
(32.7%)
30-34 years 12
(66.7%)
0 (0.0%) 3 (16.7%) 3
(16.7%)
18
(12.0%)
34+ years 6
(100.0%)
0 (0.0%) 0 (0.0%) 0 (0.0%) 6 (4.0%)
Total 92
(61.3%)
45
(30.0%)
6 (0.6%) 7 (4.7%) 150
(100.0%)
= 52.756, df = 12, p<0.001
Awal, Sazzad, Khatun, Haque and Hossain:
Incomplete Abortion ... 83
Regarding age distribution of the respondents it was found that out of 150
respondents majority (37.3%) were in the age group of 25-29 years, (28.0%) were
in the age group of 20-24 years, (17.3%) were in the age group of less than 20
years, (11.3%) were in the age group of 30-34 years and only (6.0%) belonged to
age group of 34 years and above. The mean age of the respondents was 25.14 ±
4.95 years. Most (75.3%) of the respondents had history of contraceptive use and
(24.7%) had no history of contraceptive use. It was observed that (30.0%) of the
respondent had hemoglobin level of 15 gm/dl followed by (22.7), (20.0%),
(14.0%), (9.3%), (3.3%) and (0.7%) constituted hemoglobin level of 14 gm/dl, 13
gm/dl, 16 gm/dl, 12 gm/dl, 11 gm/dl and 0.7 % respectively. About 76.0% of the
respondents complained of vaginal bleeding, (17.3%) had multiple symptoms,
abdominal pain was the complaints of 4.7% cases and a few (2.0%) had
abdominal distension. Regarding signs it was found that vaginal bleeding was the
major (93.3%) sign of the respondents followed by enlarged uterus and multiple
sign was observed in (4.0%) and (2.7%) of the respondents. Most (67.3%) of the
respondents had history of previous abortion followed by (39.3%) did not have
history of previous abortion.Regarding complication of incomplete abortion it was
found that majority (65.3%) of the respondents had chronic vaginal bleeding
followed by multiple complications constituted 25.3% , 8.0%, comprised fever
and abdominal pain. It was also observed that 1.3% of the respondents had
complained of foul smelling vaginal discharge. It was observed that the
relationship status between the age group of the respondents and the sign-
syndrome of abortion was statistically significant.
Figure 1: Distribution of the respondents by marital status
It was revealed that majority (98.67%) of the respondents was married and the rest
(1.33%) belonged to unmarried population.
4. Discussion
This cross sectional type of descriptive study was carried out with a view to find
out the situation of incomplete abortion and associated risk factors of the patients
Married
(98.67 %)
Unmarried
condition
(1.33 %)
Distribution of the respondednts by marital status
84 International Journal of Statisticsl Sciences, Vol. 18, 2019
admitted in Rajshahi Medical College Hospital and socio-demographic
characteristics of the patients with incomplete abortion. The sample size was 150
which were selected purposively. Present study showed that out of 150
respondents (37.3%) were in the age group of 25-29 years followed by (28.0%)
and (17.3%) consisted of the age group of 20-24 years and less than 20 years
respectively. The mean age of the respondents was 25.14 ± 4.95 years. Another
study showed that the abortion rate in the Philippines is within the range of 20-30
induced abortions per 1,000 women aged 15-49 (Susheela, S., et.al. 1997). The
men age of the eligible adolescents was 17.5 years (SD ± 1.3) (Sousa, A., et.al.
2010; Lema, V., et.al. 2002). Most (66%) of the women were in age group 20-29
years age (Gamzell, K., et.al. 2014; Ojha, N., et.al. 2013). Majority (75.3%) of the
respondents had history of contraceptive use and (24.7%) had no history of
contraceptive use. In another study contraceptive usage was found generally low
(Smith, S., 2013; Menezes, G., et.al. 2009). Regarding hemoglobin level it was
observed that (30.0%) of the respondent had hemoglobin level of 15gm/dl
followed by (22.7%), (20.0%), (14.0%), (9.3%), (3.3%) and (0.7%) constituted
hemoglobin level of 14 gm/dl, 13 gm/dl, 16 gm/dl, 12 gm/dl, 11 gm/dl, and
(0.7%) respectively. The hemoglobin level of the pregnant women needs to be
increased at satisfactory proportion. Majority (76.0%) of the respondents
complained of vaginal bleeding followed by (17.3%) consisted of multiple
symptoms. Majority (93.3%) of the respondents was actually suffering from
vaginal bleeding followed by enlarged uterus and multiple sign was observed in
(4.0%) and (2.7%) of the respondents. Regarding history of previous abortion it
was found that was majority (67.3%) of the respondents had history of previous
abortion followed by (39.3%) did not have history of previous abortion. Majority
of the respondents had chronic vaginal bleeding followed by multiple
complications constituted (25.3%), (8.0%), comprised fever and abdominal pain.
It was also observed that (1.3%) of the respondents had complain of foul smelling
vaginal discharge. Another study showed that most frequent complication was
septicemia (34; 79%) followed by uterine perforation with or without bowel
perforation (13, 30.2%) and hemorrhage (9; 20.9%) (Shah, N., et.al. 2011).
Majority (98.67%) of the respondents was married. Shah, N., et.al.showed that the
majority of women who had an induced abortion were married (19/29, 65.5%)
(Shah, N., et.al. 2011). It would therefore necessary to get more people informed
on safe abortion. Increased utilization of family planning would help reduce the
Awal, Sazzad, Khatun, Haque and Hossain:
Incomplete Abortion ... 85
number of unwanted pregnancy which finally results in abortions. Intensifying
reproductive health education would also assist in the reduction of complications
to abortions and to their recurrences.
5. Conclusion
The present study provided some important basic information about the
incomplete abortion and associated risk factors of the patients admitted in
Rajshahi Medical College Hospital with socio-demographic characteristics of the
patients with incomplete abortion. This cross-sectional study showed a gloomy
picture of the risk factors regarding incomplete abortion. Intensifying reproductive
health education would also assist in the reduction of complications to abortions
and to their recurrences. Reducing unsafe abortions requires a number of
strategies and consented effort from all stakeholders. There is a need for
improving contraceptive and safe abortion services. Socio-economic condition of
women especially women of reproductive age should be improved.
Ethical Consideration: During the data collection permission were taken from
the hospital authority. There was always a female doctor or nurse during data
collection.
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