Pattern of presentation and management outcomes of miscarriages in a rural private hospital in Enugu, south-east, Nigeria: A 5-year retrospective study

Background: Miscarriage and its related issues and complications are the commonest reasons for presentation in most gynaecological clinics and emergency rooms. They are major contributors to maternal morbidity and mortality requiring a more holistic review of our laws and the entire health system.

Aim: The aim of this study was to determine the prevalence and the pattern of presentation of miscarriages in a private facility.

Methodology: It was a retrospective study conducted in the above hospital over a 5-year period spanning between 31^st December 2023 and 1^st January, 2019. The relevant data was collated from the patients’ case files and hospital registers using a standardized proforma. The data collated were analyzed using the statistical products and services solution (SPSS) version 25.0. The mean percentages and ratios were calculated and the results presented in tables and charts. Pearson Chi-square test and student t-test were used as a test of significance for categorical and continuous variables respectively and a P-value<0.05 was considered statistically significant.

Results: From the hospital records and register, a total of 293 women presented to the hospital with gynaecological conditions, out of which 78 were related to miscarriages and its complications. This gives a prevalence of 26.62%. Most of the women were aged 26-30 years 23(29.5%) while the least were 31-35 years 11(14.1%). A significant proportion was less than 20 years 12(15.4%). Fifty eight (71.8%) had secondary education and only 4(5.1%) had tertiary education; more than half of the population 40(51.3%) were unemployed and only 4(5.1%) were civil servants. Majority of the women were multiparous 33(42.3%) and only 4(5.1%) were primiparous women; whereas only 47(60.3%) were married leaving 22(28.2%) and 9(11.5%) for single ladies and widows respectively.  It further showed that 42(53.8%) were 1^st trimester abortions and 51(65.4%) were induced mostly with misoprostol 32(41%) constituting the major agent of induction. Almost all of them, 74(94.9%), presented as a case of incomplete miscarriage with the most prominent features being: vaginal bleeding and abdominal pain 74(94.9%); drainage of liquor, 22(28.2%); passage of tissues per vaginam, 51(65.4%); asymptomatic, 13(16.7%). Thirty two (41%) had their cases complicated by hypovolemic shock whereas 28(35.9 had septic shock. The definitive treatments offered were medical evacuation (5.1%), MVA (94.9%). Majority of them 75.6%, had complete recovery whereas 19(24.4%) had significant morbidities and 2(2.6%) had maternal mortality from complications. There was a significant difference in the post-abortion complications between those that had spontaneous abortion and induced abortion and also the post-abortion complications between those who used misoprostol and those who had curettage or MVA; with the misoprostol group having more complications. 

Conclusion: There was a high prevalence of miscarriage in the hospital and most of which were induced with misoprostol. There was more post-abortion complication among those that had induced abortion; and these complications were yet more among misoprostol users than those that had surgical abortion with either D&C or MVA.