Abortion-related complications in Brazil: results from the World Health Organization Multi-country Survey on Abortion (MCS-A)
Authors: Veiga Junior Nelio Neves , Baccaro Luiz Francisco Cintra , Alexandrino Adriana Mendonça da Silva , Nascimento Alexandre Volta Andrade do , Clerot Camila Tereza Camilo , Santos Cintya Andreia do Nascimento , Silva Claudia Lucrécia de Matos , Albuquerque Claudio Lucio de Medeiros , Santos Débora Paulo , Gomes Demétrio Antonio Gonçalves da S. , Araújo Junior Édson Cunha de , Vilanova Elizabete das Chagas , Teixeira Georgina Costa , Santos Graciete Helena Nascimento dos , Avelar Guilherme Augusto Guerra , Barros Iara Elce Lopes , Abboud Jaqueline Polon , Lins Jeane Cristina Antas , Silva Joanne Thalita Pereira , Lucena Kelma H. Aguiar de , Barbosa Lara Wanderley Paes , Siqueira Lia Ferreira Caixeta Barreto de , Carneiro Luciana de Melo Freitas , Nagata Lucila , Lúcio Márcia de Oliveira Pereira , Silva Maria Cleane Rodrigues da , Simões Maria da Conceição Ribeiro , Magalhães Maria Fernanda da Mota , Almeida Mariana Viana , Lira Michelle Regina Faria , Souza Nádia Martins de Paula , Papa Rafael Martins , Matos Rafael Ribeiro , Pinheiro Renata Porto , Anjos Roberta Souza dos , Jesus Suelen Miranda de , Ynturias Tedy Roger Flores , Gonçalves Valéria Cristina , Caetano Viviane Resende de Abreu 
Published: January 2025

Abstract: This study aimed to describe the severity of abortion-related complications, factors associated with complications, the types of management and the experience of care in Brazil. A cross-sectional study in twenty hospitals (10 in Federal District, 3 in Rondônia and 7 in Maranhão). For 3 months, all women treated for abortion/miscarriage had their data collected. The severity of complications was defined according to World Health Organization criteria. Women with hemorrhage, infection or organs injury were invited to answer an interview about experience of care. Statistical analysis was performed using chi-square test and Poisson regression models. Among 1,683 women included, 82.5% had mild complications, 13.6% had moderate complications, 3.2% had potentially life-threatening conditions (PLTC) and 0.7% had severe maternal outcomes (SMO). Most women (94.2%) required uterine evacuation. Among these, 91.5% required surgical evacuation (with or without the use of uterotonics) and 8.5% used only uterotonics. The most frequent surgical evacuation method was curettage (66.9%), followed by manual vacuum aspiration (MVA) (32.3%). Factors associated with PLTC/SMO vs mild complications were having a gestational age ≥ 13 weeks (pravlence ratio - PR = 3.09; 95% confidence interval - 95%CI: 1.42-6.72), having been treated in Maranhão (PR = 0.27; 95%CI: 0.12-0.63) and in Rondônia (PR = 0.64; 95%CI: 0.20-0.99). Factors associated with moderate vs. mild complications were expulsion of products of conception before arrival to health facility (PR = 2.55; 95%CI: 1.64-3.96) and having been treated in Maranhão (PR = 0.58; 95%CI: 0.38-0.87). Most women who responded to the interview were treated kindly (95.6%), however, 66.7% felt stressed and 10.1% reported that their preferences were not respected during hospitalization. Nine out of ten women treated in Brazilian public hospitals due to abortion-related complications undergo some surgical procedure, the most common of which is uterine curettage. Approximately four in every hundred women experience severe complications. It is essential to ensure the supply of equipment for MVA and to encourage continuing medical education programs to increase the awareness of healthcare professionals about safer treatments for uterine evacuation.