Acute kidney injury complicating septic unsafe abortion: clinical course and treatment outcomes of 44 cases.

AIM: The aim of this study was to present the clinical course and treatment outcomes of patients with acute kidney injury (AKI) after septic unsafe abortion. MATERIAL AND METHODS: Medical records of patients with AKI after septic unsafe abortion admitted at Khon Kaen Hospital between January 2003 and December 2009 were reviewed. RESULTS: Forty-four patients with an average age of 24.3 years were included and 25% were teenage girls. The most common method of induced abortion was transvaginal chemical injection (81.8%). One patient had a hysterectomy due to severe peritonitis and sepsis that was not responsive to medical treatment. AKI developed on day 4.5 ± 3.6 with the range of onset 1-14 days after induced abortion. Oliguric AKI was present in 70.4% of patients with the mean duration of oliguria of 7.4 ± 5 days. Seventeen patients required dialysis. The mortality rate was 9%. The average duration of recovery from AKI was 24.8 ± 16.6 days. CONCLUSIONS: Conservative treatment of AKI-related septic unsafe abortion was dialysis without hysterectomy. The treatment results were minimal morbidity and mortality. Conservative management may be a better alternative to hysterectomy for the treatment of septic unsafe abortion with AKI. However the current study was a retrospective study, and we were not able to obtain certain follow-up data, such as fertility outcomes after recovery. Therefore, further study of these issues should be considered.

Factors associated with severe complications in unsafe abortion.

OBJECTIVE: To assess factors associated with severe complications in unsafe abortion and to compare the complications in unsafe abortions with spontaneous or therapeutic induced abortion at Khon Kaen Hospital. MATERIAL AND METHOD: Four hundred sixty two medical records with the diagnosis of abortion at Khon Kaen Hospital between January and December 2008 were reviewed. Patient characteristics, complications and treatment outcomes were collected. The complications from abortion were classified into mild and severe group. Qualitative data were presented as frequencies and percentage. Comparison data was analyzed by using Pearson Chi-square test. RESULTS: Out of 462 cases of abortion observed over the study period, 170 (36.8%) women had undergone an unsafe abortion. Twenty-seven (16%) women had severe complications and included 18 cases with hemorrhage requiring blood transfusions (66.6%), 17 cases with shock (63%), six cases with acute renal failure (22.2%), two cases with sepsis with DIC (7.4%) and two death cases. Ninety-five women (56%) in the unsafe abortion did not use any contraception. When compared between the mild and severe complication in the unsafe abortion group, there were statistical differences in the marital status, level of education and the method used (p = 0.003, p = 0.019, p < 0.001, respectively). Severe complications from unsafe abortion more frequently occurred in married, low educated women where intrauterine chemical injection was the most often used. CONCLUSION: The unsafe abortion had more severe complications than the spontaneous or therapeutic abortion, which had affected the women's health. Level of education, marital status, and method used were factors associated with severe complications in unsafe abortion.

Treatment of idiopathic menorrhagia with tranexamic acid.

OBJECTIVE: To determine the efficacy of tranexamic acid in the treatment of idiopathic menorrhgia and to investigate the effect of medical treatment with tranexamic acid on the quality of life of the women with idiopathic menorrhagia. DESIGN: Open, non-comparative study. SETTING: Department of Obstetrics and Gynecology King Chulalongkorn Memorial Hospital. SUBJECTS: 40 women with idiopathic menorrhagia was confirmed by menstrual blood loss greater than 80 ml/ cycle (PBAC score > 100) and mid-luteal serum progesterone concentration greater than 5 pg/ml. INTERVENTION: Treatment with tranexamic acid 1 g orally, three times daily, for five days from day 1 of the menstruation for two consecutive menstrual periods. MAIN OUTCOME MEASURES: Menstrual blood loss was measured using the pictorial blood loss assessment chart (PBAC). Hematological assessments were made at the beginning, after the first treatment cycle and at the end of the study. Questionnaires were given to assess subjective endpoint, quality of life. Patients were asked to report any adverse event during the study period. RESULTS: Tranexamic acid reduces the mean PBAC score by 49%, from 350.5 to 178.6. Regarding the change in the quality of life measures, the proportion of women who felt a considerable degree of impairment during the menstruation was reduced from nearly 60% to less than 5% during their third menstruation. No serious adverse events were reported. CONCLUSION: Tranexamic acid is a safe and effective form of medical therapy in women with menorrhagia; also increases quality of life in these women.