Retrospective study of 600 consecutive admissions with abortions at Kamuzu Central Hospital.

In Malawi, physicians analyzed retrospective data on 600 consecutive abortion cases who were admitted to the gynecology ward at Kamuzu Central Hospital in Lilongwe during January-May 1990. These cases comprised 45% of all admissions to this ward during the study period. 71% of the patients had first-trimester abortions and 29% had second-trimester abortions. 85% of cases were admitted with incomplete abortion, 38% of whom were septic. 38 abortion cases required a blood transfusion. The gravidity group with the greatest number of patients was the primigravidity group (about 170), followed by gravidities 3 and 2 (100 each). 33 (5.5%) women had an obvious induced abortion. There may have been more induced abortions, since women tend not to admit to induced abortion. 24 of the obvious induced abortion patients were students and primigravidae. Six women, all of whom had an induced abortion, required major surgery. Three of these women died. An educated mother of four sought the help of a traditional healer who had induced the fatal abortion with sticks. The healer had perforated the left cornu of the uterus, which later necrotized. Surgeons performed a subtotal hysterectomy with bilateral salpingo-oophorectomy. Traditional healers also used sticks to induce an abortion in a 20-year-old student and a 22-year-old student, resulting in a perforated uterus in both cases. Necrosis of the uterus developed. Surgeons performed a subtotal hysterectomy in both cases. The 20-year-old died 19 days later. The 22-year-old recovered. The other two surgery patients were 20- and 22-year-old primigravidae. Sticks were used to induce their abortions. Surgeons performed laparotomy on and drained pus from the 22-year-old. Postoperatively, she suffered from a burst abdomen. She was HIV-positive. The 20-year-old suffered from a perforated uterus and a hematoma in the right broad ligament. Surgeons performed a total hysterectomy. Both women recovered.