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Background. Although the vast majority of abortions are performed in the first trimester, still 10-15% of terminations of pregnancies have taken place in the second trimester globally. As compared to first trimester, second trimester abortions disproportionately contribute to maternal morbidity and mortality especially in low-income countries where access to safe second trimester abortion is limited. The objective of this study was to identify factors affecting and outcome of induced safe second trimester medical abortion in Jimma University medical center, Southwest Ethiopia. Methods. Institution based cross-sectional study design was used to conduct a study among women who seek safe second trimester medical abortion services and admitted at gynecology ward. All (201) eligible study subjects included were those who came for safe medical abortion service during data collection period. Data collected using pretested structured questionnaire through exit-interviewing and some clinical data abstracted from their chart. The data was entered into EpData version 3.1 then exported to SPSS version 21.0 for analysis. Variables with P-value less than 0.25 in bivariate analysis were entered into the final predictive model. Multivariable logistic regression was used to identify determinants with 95% CI and P-value < 0.05. Hosmer and Lemeshow test were used to check model fitness at P-value of 0.05. Ethical clearance was obtained and confidentiality kept using codes and patient's chart number. Results. In this study the response rate was 98.1%. Out of 201 women who participated in the study and were addmitted for safe second trimester medical abortion, 154 (76.6%) of them had complete abortion without any complication while the remaining 47 (23.4%) had incomplete abortion with one or more complication. Previous experience of abortion [AOR= 6.00, 95% CI= (3.77, 8.88)], gestational age [AOR=0.90, 95% CI= (0.07, 0.99)], parity [AOR=2.38, 95% CI= (1.04, 3.69)], cervical status [AOR=8.00, 95% CI= (5.72, 10.02)], overall waiting time for more than two weeks [AOR=0.53, 95% CI= (0.50, 0.96)], overall waiting time for two weeks [AOR=0.05, 95% CI= (0.01, 0.45)], and moderate anemia -(Hgb:7-10g/dl)-[AOR=0.07,95% CI= (0.01, 0.16)] were independent predictors for outcome of safe second trimester medical abortion. Conclusion. This finding implied that proportion of complete abortion without any complication overweighs incomplete abortions with one or more complication through induced safe second trimester medical abortion method. The outcome is strongly determined by gestational age, cervical status, previous experience of abortion, parity, moderate anemia, and overall waiting time. Induced second trimester medical abortion is already known as an effective and safe method. However, much should be done to reduce proportion of incomplete abortions by minimizing overall waiting time through intervening at low gestational age. Therefore, it is recommended that safe second trimester medical abortion services should be continued under a certain legal circumstances so as to reduce maternal morbidity and mortality.
The study was conducted in Jimma University Medical Center (JUMC), Obstetrics, and gynecology ward, comprehensive abortion (CAC) clinic, from November 1, 2016, to June 30, 2017. The center is found in Jimma town which serves a catchment population of about 15 million people. It is located 352 km southwest of Addis Ababa. The center has annual out-patient case load of 160, 000 and 45, 000 in-patients. It provides services to diverse population from three regional states: namely, Oromia, Southern Nations, Nationalities and Peoples, and Gambella. It was estimated that 180 women were admitted for safe second trimester induced medical abortion (2nd TM-MA) over a period of 6 months from previous year record. The average rate of admission for 2nd TM-MA was 30 clients per month. A facility based cross-sectional study design was used by considering all clients admitted for CAC services in Obstetrics and gynecology ward as a source population. All clients admitted for safe 2nd trimester induced medical abortion during the study period were considered as a study population. Only clients admitted for safe 2nd trimester medical abortion services without prior complication were included, whereas those who already had known medical and obstetric complications were excluded if that was an indication for admission and termination. Sample size was calculated using a single population proportion formula, taking P = 50% (since there is no previous study conducted on outcome and determinants of safe second trimester medical abortion), n = z2p(1-p)/d2, n = 1.962(0.5)(0.5)/0.052, n = 384. Assumption: The total estimated source population from the previous record is 180 that was less than 10,000. Hence, finite population correction formulae were used to adjust the sample size. The required sample size was 136 but all eligible subjects included considering the sample size to be more than 136 to maximize statistical power. A consecutive sampling technique was employed to include all eligible subjects who came to JUMC for safe second TM-MA services during the study period. The dependent variable is the outcome of safe second TM-MA and independent variables are categorized under sociodemographic characteristics (age, religious affiliation-to see religious based attitude towards abortion, ethnicity, marital status, educational status, occupational status, place of residence, and own monthly income), services and perception related variables (distance from facility, service availability, referral system, transportation cost, services cost, perception towards physician skill and abortion, waiting time, and satisfaction), and obstetrics and gynecology related variables (history and type of contraceptive use, menses status, previous experience of abortion, reason for delayed termination, gestational age, gravidity, parity, status of anemia, cervical status, procedure type, and expulsion time). Important variables are operationalized as follows: Interviewer-adiminstered structured questionnaire was developed after reviewing relevant literature. A two-day training was provided for all data collectors and supervisors prior to actual data collection. Translated, pretested (5%), interviewer administered, and structured questionnaire was used to interview women at exit or during discharging process. Midwife nurses conducted exit interviews. Obstetrics and gynecology residents completed the clinical or technical part of the questionnaire from the client's chart under the supervision of the principal investigator. All questionnaires were reviewed and checked on daily bases by supervisors to assure quality of data and its completeness. Clinical data were completed by reviewing client's chart. Following the participants received the service as per the clinical standard, their respective clinical findings were recorded from their chart such as gestational age, gravidity, parity, status of anemia, cervical status, procedure type, expulsion time, retained products of conception/incomplete abortion, hemoglobin level, cervical/uterine/abdominal injury, shock, infection, vaginal wall lacerations, and need of transfusion. Data were checked for completeness, consistency and entered into EpData version 3.1. SPSS version 21.0 was used for statistical analysis including cleaning. A logistic regression model was used to identify explanatory variables and to control for confounding variables. Candidate variables at p- value<0.25, in bivariate analysis, were entered into multivariable logistic regression. Binary logistic regression analysis was used to see the values of COR which was declared as significant at p-value < 0.05. Backward model selection method was used. The degree of association between dependent and independent variables was assessed using an adjusted OR with 95% CI at p-value < 0.05. The Hosmer and Lemeshow test were used to check model fitness at P-value of 0.05.
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