Risk factors for intrauterine device failure: a review.

After reviewing the literature on intrauterine devices (IUDs) published over the last 30 years, we selected and analyzed recent and most relevant (with appropriate methodology design) articles dealing with the risk factors for IUD failure. There is sufficient evidence to conclude that the TCu380 and levonorgestrel-releasing (LNG) IUD are the most effective, with a cumulative pregnancy rate of less than 2% at 12 years for the TCu380 and around 1% for the LNG IUD at 7 years. In addition, advancing age increases IUD effectiveness, and displacement of the IUD decreases effectiveness. The IUDs with the highest copper concentrations are clearly less prone to failure than those with lower copper concentrations.

Complications of induced abortion and miscarriage in three African countries: a hospital-based study among WHO collaborating centers.

OBJECTIVE: The aim of this study was to describe two of the outcomes of pregnancy, induced abortion and miscarriage, in three African countries. Major maternal risk factors were also evaluated. METHODS: The study was prospective and based on the medical files of all 1,957 women admitted to participating health care structures. RESULTS: Overall, 988 women were admitted for complications of miscarriage, and 969 for complications of induced abortion. Gestational age was lower in women with miscarriages (p<0.002). The level of use of contraceptive methods ((p<0.003) and educational level ((p<0.005) were lower in women who had had an induced abortion. In our study, 26 maternal deaths were recorded, 22 of which were associated with induced abortion. Infection was the most important risk factor for death (OR=4.8; 1.9-12.4). CONCLUSION: Maternal deaths related to abortion complications often occurred shortly after hospital admission and with signs of sepsis. This demonstrates the importance of effective emergency services. Unfortunately, hospital-based studies alone cannot assess all maternal death risk factors, especially those for maternal death related to induced abortion complications. It is therefore important to determine what happened to the woman before hospital admission and during her stay in hospital. Combinations of qualitative and quantitative methods could be used to increase our understanding of this problem and to help us to solve it.

Abortion complications in Abidjan (Ivory Coast).

The aim of this study was to describe the various methods of abortion used by women admitted to an obstetrics department in Abidjan (Ivory Coast) for abortion complications. The study was retrospective, and was based on the medical files of all 472 women admitted for abortion complications during a 3-year period (1993-1995). The introduction of plant stems into the uterus, the use of certain instruments, use of vaginal preparations, and ingestion of plants were the most common abortion methods. Seventeen maternal deaths were registered, giving a maternal mortality rate of 3.6%. A high number of previous pregnancies and the ingestion of plants to provoke abortion were factors associated with the highest risk for maternal death. Complications of "local" abortion methods accounted for a high proportion of maternal deaths.

PIP: A retrospective study was undertaken to assess the effect of various abortion practices on maternal health. The study was based on the medical files of all 472 women admitted to an obstetrics department in Abidjan, Ivory Coast, for abortion complications during a 3-year period (1993-95). The medical records of the sociodemographic and medical characteristics of women upon admission were assessed. Results demonstrated that the introduction of plant stems into the uterus was the most frequently used abortion method (31%), followed by herbal pessaries (23%) and plant infusions (20%). About 17 maternal deaths were registered, giving a maternal mortality rate of 3.6%. A high number of previous pregnancies and the ingestion of plants to provoke abortion were the factors associated with the highest risk of maternal death. Furthermore, complications resulting from local abortion methods accounted for a high proportion of maternal deaths. From the results, it was found that the potential lethal risks associated with local abortion methods were high. These results suggest that more rapid and efficient hospitalization in abortion cases and greater access to family planning would reduce the rate of maternal mortality in Ivory Coast.

Trends and causes of maternal mortality in Kazakhstan.

OBJECTIVE: The aim of this study was to determine trends in the rate and causes of maternal mortality in Kazakhstan. METHODS: Maternal deaths occurring between 1960 and 1996 in the 19 oblast (administrative regions) of Kazakhstan were documented and analyzed. RESULTS: After an initial phase of decrease in the period 1960-1980, the level of maternal mortality in Kazakhstan has been stable at 70-80 maternal deaths per 100,000 live births. Maternal deaths due to hypertension and abortion complications have not substantially decreased. Over the last 10 years, illegal abortions have accounted for most Kazakh maternal deaths resulting from abortion complications. CONCLUSION: To reduce the maternal death rate, the Kazakh health authorities and health workers (obstetricians, midwives, health educators) must develop and rapidly implement maternal health and family planning policies.

PIP: Trends in the rate and causes of maternal mortality in Kazakhstan's 19 administrative regions were assessed, in 1960-96, through a review of data submitted to the National Statistics Office. Each of these regions has 1-3 reference maternity units with obstetric and surgical facilities and all pregnant women are offered a free monthly antenatal visit. Following an initial phase of decrease in 1960-87, maternal mortality has remained stable at 70-80 maternal deaths/100,000 live births. Over the last 20 years, maternal deaths related to uterine rupture have declined sharply. Hemorrhage, infection, and hypertension also cause fewer maternal deaths than in the past, but their incidence remains unacceptably high. Maternal deaths attributable to abortion complications (primarily of illegal procedures performed outside of hospitals) gradually decreased until 1984, then stabilized and now comprise 33% of all maternal mortality. These findings suggest a clear need for implementation of maternal health and family planning policies aimed at reducing the maternal death rate. Although deteriorating socioeconomic conditions in Kazakhstan have reduced couples' desired family size, modern hormonal or barrier contraceptive methods are not widely available.

[Obstetric complications of the first trimester in Western Africa]. / Complications obstétricales du premier trimestre en Afrique de l'Ouest.

The obstetrical complications affecting women in Benin, Senegal and Ivory Coast during the first trimester of pregnancy were studied. Information about the 345 women included in the study was collected from registers maintained by the eight participating maternity units. The most frequent complications observed were spontaneous abortions (50% of admissions), complications of induced abortions (34%), and ectopic pregnancy (8%). Overall, the patients appear to have gained rapid access to care: two thirds of the women underwent interventions on the day of admission. Nevertheless, there were three maternal deaths, two of which followed induced abortion complications.

[Maternal mortality in Guinea: magnitude and perspectives]. / Mortalité maternelle en Guinée: mesure et perspectives.

In recent years maternal mortality in developing countries has become a public health priority for international organizations. However, measuring the true magnitude of this problem is the subject of much methodological debate. In less than a century, the rate of maternal mortality in most industrialized countries has decreased one hundred-fold. In contrast, the rate remains very high in most developing countries, particularly in Africa. In this article based on the studies conducted in Guinea we review various operational proposals which may contribute to improving maternal health and reducing maternal morbidity and mortality, with particular reference to the work of the French speaking organization "Santé Maternelle Internationale".