Two hundred and twelve patients were admitted because of complications of induced abortions. 58% of those abortions had been performed outside designated health institutions despite the liberalisation of the abortion law in Ghana about ten years ago. Ghanaian society still seems to perceive abortions as illegal or unethical and hence to be procured clandestinely. The overall mortality rate was 2.4% whilst the case fatality rate for septic abortions was over three times this rate. The surgical intervention rate was high at about 94%. Over 50% of laparotomies were for ectopic pregnancy. Suspicion of ectopic pregnancy must always be borne in mind if undue delay in their management is to be avoided in all cases of complicated induced abortions especially when the patients have risk factors. None of the patients used a modern contraceptive method over the three months preceding the index pregnancy and post-arbortal contraceptive counselling was infrequent. Effective and widespread contraceptive use and continuing education of doctors remain pivotal if the incidence of abortions and their complications are to be reduced.
PIP: Although Ghana's abortion law was liberalized 10 years ago, widespread cultural and religious disapproval of pregnancy termination persists and unhygienic, clandestine induced abortions are common. The records were reviewed of 212 women admitted to Korle-Bu Hospital in a 12-month period during 1993-94 with complications from induced abortion. 85 (40.5%) of these women were 15-20 years of age and none had used a modern contraceptive method in the 3 months preceding the pregnancy. Over 95% of women were self-referred to the hospital at a time interval ranging from the day of the procedure to 2 months after abortion. 58% of pregnancy terminations were performed outside legally designated health institutions and 30% were self-induced. Sepsis was present in 15.7% of cases from health institutions and 21.5% of those from unregistered premises or self-induced. Of the 5 deaths in this series (2.4% mortality rate), 2 involved self-induction. The case fatality rate for septic abortion was 7.5%. 85.7% of the patients required surgical intervention and 17.6% received blood transfusions. Over 10% of the women required laparotomy, generally for ectopic pregnancies mistaken for intrauterine pregnancies. 56% of the women spent 1-3 days in the hospital, while 24.3% required 7 or more days. Postabortal counseling and contraception had been provided in only 13.5% of non-self-induced abortions. Recommended are educational campaigns on pregnancy prevention, easy access to reliable contraception, training and continuing education on abortion and its complications for physicians, regular inspection and monitoring of registered clinics to ensure hygienic conditions, and public debate on the amended abortion law.