Low-fidelity simulation for management of postpartum haemorrhage in a Ghanaian teaching hospital

We conducted a pre/post study of a post-partum hemorrhage (PPH) simulation exercise at Korle Bu Hospital, using a low-fidelity birthing simulator and questionnaires. We aimed to evaluate low-fidelity simulation as a feasible and effective method of improving resident knowledge and confidence in a low-resource setting. Knowledge and confidence in PPH management were measured before and after using 5-point Likert scales and multiple-choice questions. A feedback survey was administered. Descriptive statistics were calculated to summarize demographics, confidence, and knowledge, with frequencies, means and standard deviations reported. Statistical significance of the change in scores was assessed using paired t tests. Statistically significant improvements in knowledge and confidence in managing PPH were evident following the simulation exercise. All participants agreed the simulation was educational, relevant and realistic, and 94% felt it could be incorporated into their training. (Afr J Reprod Health 2022; 26[4]: 57-64)

Mortalité maternelle chez les adolescentes au service de Gynécologie-Obstétrique de l'Hôpital National Ignace Deen / Maternal mortality among adolescents in the Gynecology-Obstetrics department of Ignace Deen National Hospital

Introduction. L'objectif de cette étude était de contribuer à l'étude de la mortalité maternelle chez les adolescentes. Méthodes. Il s'agissait d'une étude retro-prospective descriptive et analytique cas témoin, d'une durée de trois ans. La collecte rétrospective avait porté sur deux (2) ans allant du 1er Janvier 2018 au 31 Décembre 2019 et celle prospective sur un (1) an allant du 1er Janvier 2020 au 31 Décembre 2020. Résultats. Durant la période d'étude nous avons enregistré 38 cas de décès maternels sur 16175 naissances vivantes soit un ratio de 235 décès pour 100000 naissances vivantes. Le décès concerne l'adolescente de 18-19 ans (65,8%), mariée (63,2%), non scolarisé (42,1%), et nullipare (65,8%). La majorité des adolescentes avait effectué 1-3 CPN (44,7%), et provenait d'une maternité périphérique (84,2%) et avait accouché par voie basse (78,4%). Le moyen de transport le plus utilisé était le transport en commun (63,2%). La cause de décès était dominée par l'hémorragie (44,7%). Le post-partum a été la période la plus pourvoyeuse de décès (52,6%). Conclusion. La mortalité maternelle constitue un problème de santé majeure dans notre pays, sa réduction nécessite la mobilisation de tous les acteurs de la société et implique une bonne éducation pour la santé, l'amélioration de la qualité du suivi prénatal et celle des soins obstétricaux d'urgence.

Introduction. The objective of this study was to contribute to the study of adolescent maternal mortality. Methods. This was a retrospective descriptive and analytical case-control study, lasting three years. The retrospective data collection covered two (2) years from January 1, 2018 to December 31, 2019 and the prospective one over one (1) year from January 1, 2020 to December 31, 2020. Results. During the study period we recorded 38 cases of maternal deaths out of 16,175 live births, ie a ratio of 235 deaths per 100,000 live births. The death concerns an adolescent girl aged 18-19 (65.8%), married (63.2%), out of school (42.1%), and nulliparous (65.8%). The majority of adolescent girls had performed 1-3 ANC (44.7%), and had come from a peripheral maternity hospital (84.2%) and had given birth vaginally (78.4%). The most used mode of transportation was public transit (63.2%) The cause of death was dominated by hemorrhage (44.7%). The postpartum period was the most significant period of death (52.6%). Conclusion: Maternal mortality is a major health problem in our country, its reduction requires the mobilization of all actors in society and involves good health education, improving the quality of prenatal care and that of obstetric care emergency

An Evaluation of Risk Factors Associated with Pregnancy Related Acute Kidney Injury in Women Admitted to the High Dependency Care Unit at Women and Newborn Hospital, Lusaka-Zambia

Objective:To evaluate factors associated with Pregnancy-related KidneyInjury(PRAKI) inwomen admitted to high dependency care unit at Women and Newborn Hospital in Lusaka, ZambiaMethodology:This was an unmatched case-control study conducted in the high-dependency care unit at Women and Newborn Hospital in Lusaka. Study participantswererecruitedconsecutivelybyconveniencesampling.Participants'medicalrecords were reviewed to capture serum creatinine levels;whileastructuredquestionnairewasadministeredto eligible andconsentedstudy participants to capture data on sociodemographic, obstetric, and medical factors. Serum creatinine levels above 84µmol/l were used as criteria for classifying PRAKI. Excel was used for data cleaningandStatav13usedforanalysis.Descriptive statistics were done for all variables followed by univariate and multivariable logistic regression to determine association. 95% CI was usedand p value of<0.05 was consideredsignificant.Results:Thestudy comprised of185 study participants, split into 85 women with PRAKI (cases) and 100 women without PRAKI (controls). The median age was 29 years with 11years interquartile range. 75.3%of the study participants wereinmarriagerelationships.Pre-existinghypertension was the most prevalent medical condition in both the cases (51.8%) and the controls (38%). Sickle celldisease was much less common at 1.2% in cases and 8% in controls. Among the obstetric conditions, preeclampsia was the most common condition at 77.6% and 60% in cases and controls respectively. Eclampsia was found in 38.8% of cases and 11% of controls. Sepsis was least common at 4.7% of cases. This study found that obstetricfactorssuch as eclampsia (AOR = 5.12, 95% CI [2.14 ­ 12.23]; p≤0.0001), preeclampsia (AOR = 2.46, 95% CI [1.12 ­ 5.39]; p = 0.025), and postpartum haemorrhage were associated with the development of PRAKI. Medical conditions were not associated with PRAKI.

Knowledge and utilization of non-pneumatic anti-shock garment for the management of postpartum hemorrhage among midwives in government hospitals in Ogun State, Nigeria

Objective: To assess the knowledge and determine the level of utilization of Non-Pneumatic Anti-Shock Garment (NASG) for the management of PPH among Midwives.Method: The study employed a descriptive cross-sectional study design, using a validated self-administered questionnaire. A total of 198 randomly selected midwives across three health facilities in Ogun State participated in the study. A 10-point knowledge scale was used to assess the knowledge of midwives on NASG. Descriptive statistics were used to determine the level of utilization of NASG among midwives, while Chi-square statistics were used to determine the relationship between the dependent and independent variables of interest at p<0.05 level of significance.Results: Most (88.9%) of the respondents were female with a mean age of 40.2±5.6years. Most (48.5%) had a BNS degree. The majority (74.7%) of the respondents were aware of NASG. Close to a half (49.3%) of the respondents had fair knowledge scores, 34.5% had good knowledge scores, while 16.2% had poor knowledge scores. Only 22.7% of the respondents had ever used NASG in the management of PPH; 77.3% never used it before. Also, 67.2% of the respondents reported NASG was not available in their facilities. There was a significant influence of knowledge of NASG on the utilization among midwives (X2=37.151, P<0.05, df=2).Conclusion: This study demonstrated that midwives in healthcare facilities were aware, but did not have good knowledge of NASG. The utilization of the garment for the management of PPH was also very poor, probably due to suboptimal knowledge and non-availability of the garment

A seven-year review of emergency obstetric hysterectomy in a Nigerian tertiary institution

Background:Extirpativeuterinesurgeries for near-miss events are usually thelast resort when other conservative measures fail.Emergency obstetric hysterectomy(EOH)may still have a significant role where there are limited options.Objectives:To determine the prevalenceof EOH, theassociatedfactorsandthe foeto-maternal outcomeat the Olabisi Onabanjo University Teaching Hospital, Nigeria.Methods:This was a retrospective observational study covering sevenyears (January 2010 to December 2016). The case records of patients who hadEOH during this period were retrieved for data extraction. Results:There were 5,608 deliveries and 31 cases requiringEOH giving aprevalence rateof31/5,608(0.55%). The mean age of the patients was 30.3±4.2years, whilethe mean gestational age at delivery was 36.3±5.1 weeks. Most of thepatients16/25(64.0%) were of higher parity (>3), and12/25(48%)of the patients were within the age bracket of 25-34 years. Subtotal hysterectomywas the most common procedure(18; 72.0%), andruptured uterus wasthe main indication for EOH (40.0%). The twomost common interventions that were critical to survival includedmassive blood transfusion (24.0%)andIntensive Care Unit admission (20%).Two (8%)maternal deathsand 58.3% perinatal mortality wererecorded.Conclusion:EOH is still relatively frequently performedat this centredue tothehigh incidence of a ruptured uterus. Effortsshould be made to increase the proportion of deliveries attended by skilled personnel and improvethe capacity of lower levelhospitals for comprehensive emergency obstetric care

A Single Large dose of tranexamic acid before vaginal delivery: Is it beneficial?

Background: many factors are attributed in the management of postpartum hemorrhage after vaginal delivery.Objective: to assess the efficacy and safety of a single large dose of intravenous tranexamic acid in reducing postpartum blood loss after vaginal delivery.Subjects and Methods: this is a multicentric prospective randomized double blind placebo controlled trial.240 pregnant women were randomized to receive either 60 mg/kg of TA (n=120) or placebo (n=120) intravenously in the second stage of labour. Postpartum blood loss was collected and measured accurately from placental delivery to 2 hours postpartum and adverse effects of were observed.Results: the mean estimated postpartum blood loss was significantly lower in women treated with tranexamic acid compared to women in the placebo group(241.5 � 82.7 versus 322.8 � 127.4, respectively; p < 0.001),and the proportion of women in the tranexamic acid group who had an estimated blood loss 500 mL was significantly lower than in the placebo group ( 5 [4.2%] versus 18 [15%], relative risk [RR]=0.30; 95% confidence interval [CI] 0.11 to 0.78; P<0.05).Maternal and neonatal outcomes did not differ significantly between both groups.Conclusion: A single large dose of tranexamic acid administrated intravenously before vaginal delivery significantly reduces the amount of postpartum blood loss and contributes to prevention of PPH. Adverse effects were only mild and transient. Thus, tranexamic acid can be used safely and effectively to reduce bleeding after vaginal delivery

Role of national blood transfusion service (NBTS) in promoting emergency obstetrics care (EMOC)

Background: Obstetrics haemorrhage is one of the leading cause of maternal mortality in our settings, this was compounded by the non availability to safe blood in situation of need. Hence the prompt access and availability of blood can avert this preventable cause of maternal death. Objectives: to highlight the benefits of effective collaboration with NBTS in ensuring prompt availability of blood for emergency obstetric services requiring blood for transfusion. Material And Method: All obstetrics cases requiring blood transfusion in FMC Nguru from 1st stJanuary 2006 ­ 31 December 2011 were retrospectively reviewed. Trends and pattern of the st strequest and source of blood were looked at within the two periods (from 1 January 2006 ­ 31 st stDecember 2008 and 1 January 2009 ­ 31 December 2011). Records of 1634 obstetric patients requiring blood transfusion or received blood transfusion in the maternity units were retrieved from the medical records, maternity ward record and blood bank. Information pertaining to their age, parity, indication for the transfusion or requests and source of blood was obtained for analysis. Data was analysed using simple percentage. st st Results: Between 1 January 2006 and 31 December 2008 only 513 (56%) of the units requested st st907 units of blood were supplied, while between 1 January 2009 and 1 December 2011 1367 ( 87%) of the 1567 units of blood requested were supplied. Within the earlier study period the only available source were from willing relatives and commercial blood donors, however between 2009 and 2011 more than 2/3 (64.2%) were supplied from the north east zonal NBTS office in Maiduguri. In 2006 through 2008, donation from relatives and commercial donors accounted for 53.22% and 46.78% respectively, but in 2009 and 2011 donation from relatives and commercial donors were recorded as 23.9% and 11.6% respectively. The commonest indication for the requests were anaemia, obstetrics haemorrhage (PPH, APH) and emergency C/S. Conclusion: Ready available source of blood will significantly improve timely availability of blood in our setting. There is the need to encourage this collaboration in other regions to ensure prompt availability of blood to attend to emergencies requiring blood transfusion

Hémorragie du post-partum immédiat : technique de méchage

Le Méchage intra-utérin (MIU) est une technique d'étape importante pour stopper l'Hémorragie du post-partum (HPP); il est pratiqué après l'inefficacité des moyens médicaux et avant l'étape chirurgicale. Les préalables pour une PEC efficace sont évoqués puis une description détaillée de la technique de méchage est faite, terminée par une étude portant sur 265 cas d'HPP sur 7 ans dont 119 cas de méchage. Avec 93,3% de taux de succès et un coût très faible, le MIU est très efficace dans la PEC de l'HPP. Aucune complication à court ou long terme n'est constatée dans la cohorte présentée. 58 cas de grossesses spontanées sont constatés par la suite

La problematique des parturientes evacuees en zone rurale senegalaise : exemple du centre hospitalier de Ndioum

Objectifs : Decrire les difficultes rencontrees par les parturientes evacuees dans une zone rurale au Senegal. Methodologie : Etude prospective sur une periode de 12 mois allant de janvier a decembre 2011. Toutes les patientes evacuees vers la maternite. Resultats :La frequence des evacuations obstetricales etait de 31;2. Le nombre moyen de consultation prenatale etait de deux. Une femme sur 3 avait effectue plus de 4CPN (33;3). La grossesse etait a terme dans 83;6 des cas. La distance parcourue etait en moyenne de 48 Km avec des extremes de 1 a 200 km. L'evacuation etait faite au moyen d'une ambulance dans 69 des cas et celle-ci etait accompagnee par un prestataire non qualifie dans 92;7 des cas. La patiente etait vivante bien portante dans 98 des cas. L'enfant etait ne vivant bien portant dans 75;4. La duree de sejour moyenne etait de 2;6 jours avec des extremes de 1 et 12 jours. La contre-reference etait effectuee dans 97;3 des cas. Conclusion : Les resultats de notre etude nous permettent de confirmer malgre les ressources limitees; il est possible de prendre en charge et de reduire la morbidite et la mortalite des patientes evacuees. En effet nous preconisons de mettre en place un systeme de SAMU obstetrical en zone rurale afin de contribuer a la regulation des evacuations obstetricales; mais surtout de permettre aux patientes a faible revenu d'acceder au service

L'hemorragie grave du post partum; epidemiologie et prise en charge a l'Hopital

Introduction : L'hemorragie grave du post partum est une urgence obstetricale imprevisible mettant en jeu le pronostic vital et fonctionnel. Elle reste la principale cause de mortalite maternelle dans notre pays et ailleurs Buts : Rapporter l'experience de la maternite universitaire de Nabeul dans la prise en charge de l'hemorragie grave du post partum. Patientes et methodes : etude retrospective; descriptive; couvrant la periode de 2009 a 2011; et portant sur 92 dossiers des patientes ayant presente une hemorragie grave du post partum.. Resultats : Pres d'une patiente sur deux (46;8) avait moins de 30 ans. La frequence de l'hemorragie grave du post partum a ete de 6;03 pour mille accouchements. Les paucipares ont represente la majorite dans cet echantillon (69;6).La pre-eclampsie (21;7); l'hematome retro placentaire (14;1); et la macrosomie fotale (5;4); ont ete les principales associations morbides La cesarienne a ete le principal mode de delivrance dans ce groupe (68;5). Le diagnostic a ete souvent etabli en postpartum immediat (2h) avec une estimation moyenne du saignement de 1278ml. Le taux moyen d?hemoglobine au moment du diagnostic etait de 7;75 g/dl. Des troubles graves de l?hemostase avec CIVD ont ete retrouves chez 5 patientes (5;43). Les etiologies etaient dominees par l'inertie uterine (92;39 ); les lesions genitales basses (12.88) et la rupture uterine (3.68). Le Sulprostone a ete utilise chez 86 patientes (93;5). Trente sujets (32;6) ont necessite un recours a la chirurgie reparatrice; contre 62 (83;3) qui ont beneficie d'un traitement conservateur. Dans 5 cas; une hysterectomie d'hemostase a ete indiquee. Aucun deces maternel n'a ete rapporte. Conclusion : L'hemorragie grave du post-partum est une complication presente dans notre milieu ; elle concerne surtout la jeune parturiente et justifie des mesures preventives adequates ciblees sur les principales causes et les complications observees

Les hemorragies de la delivrance : a propos de 134 cas referees a la maternite du CHU de Treichville

Objectifs : Determiner la frequence des patientes referees pour hemorragie du post partum immediat (HPPI); decrire les caracteristiques socio-demographiques des patientes et identifier les dysfonctionnements pouvant aggraver le pronostic maternel. Population et methode : Etude descriptive et retrospective menee de janvier 2005 a juin 200 incluant toutes les patientes referees a la maternite du CHU de Treichville pour HPPI. Resultats : 134 patientes ont ete referees pour HPPI soit une incidence de 1;27. L'age moyen des patientes etait de 28;5 ans. La parite moyenne etait de 3;5. La majorite des patientes etaient sans activite remuneratrices et sans niveau d'instruction. La decision de transfert etait decidee dans 85;82 des cas par la sage femme. Le transfert avait ete assure par de vehicules non medicalises (86;58). La duree moyenne d'evacuation etait de 62;7min. A l'admission; 47;76 etaient en etat de choc hypovolemique avec dans 16;42 une coagulation intravasculaire disseminee. Trente et six patientes sont decedees soit un taux de letalite de 26;90. Les principales causes de deces etaient la coagulopathie (55;6) et le choc hypovolemique (36;1). Conclusion : Le taux de letalite par hemorragie de la delivrance chez les patientes referees est eleve. Sa reduction passe par l'amelioration des dysfonctionnements identifies dans l'itineraire therapeutique des patientes

Emergency Obstetric Hysterectomy in a Tertiary Hospital in Sokoto; Nigeria

Emergency obstetric hysterectomy (EOH) is a life-saving procedure which is often performed to treat some obstetric complications; as a last resort; to prevent maternal mortality. Objectives: This study was designed to determine the rate; indications; and complications of the EOH procedure at Usmanu Danfodito University Teaching Hospital (UDUTH); Sokoto. Materials and Methods: This retrospective study involved all the patients who had EOH at UDUTH; Sokoto; Nigeria; between January 2005 and December 2010. The case records of these patients were retrieved from the medical record library and information relating to age; parity; booking status; indications; type of hysterectomy; cadre of the surgeon; type of anesthesia; and complications of the procedure were extracted. The data were processed via SPSS version 11.5 and the ?2 test was used to analyze some of the results with the confidence limit set at 95. Results: During the 6-year period; 83 EOH were performed out of 16;249 deliveries giving the rate of the former as 0.51; i.e. 1 in 196 deliveries. However; the case records of only 74 patients (82.9) were available for the study. The rate of EOH increased with advancing maternal age and increasing parity. The majority of the patients (89.2) were available for the study. The rate of EOH increased with advancing maternal age and increasing parity. The majority of the patients (89.2) were unbooked for antenatal care; and the rate of the procedure among these patients (1.82) was significantly higher than 0.07observed amongst booked subjects (P0.001). The main indication for the procedure was ruptured uterus (93.2) and the majority of the patients (95.9) had subtotal hysterectomy. Anemia (66.2); excessive hemorrhage (35.5); septicemia (18.9); and wound infection (16.2) were the leading complications. Excessive hemorrhage was significantly higher in the procedure performed by the senior registrars (51.2) compared to those undertaken by consultants (16.2); P

Retained Placenta: Still a Cause of Maternal Morbidity and Mortality in a Nigerian Semi- Urban Population

Background: Retained placenta is associated with morbidity and mortality when left untreated. This study was done to determine the occurrence of retained placenta in our setting as well as to ascertain the possible risk factors; morbidities and mortality. Method of study: This was a retrospective review of all cases of retained placenta over a three year period (March 2005 to March 2007). There were 3542 deliveries; and of which 64 cases were of retained placenta. Results: The incidence of retained placenta was 1.8of all deliveries with a higher incidence in unbooked patients and a case fatality of 3.12.The commonest complication was postpartum haemorrhage in 51(79.68) of cases with blood transfusion rate of 47. onclusion: Complications associated with retained placenta could be reduced by adequate utilisation of health care facilities manned by skilled attendants; availability of blood transfusion services as well as effective and safe anaesthesia

Les hysterectomies obstetricales realisees au service de Maternite du CHU de Toamasina Madagascar

Objectif: Decrire les facteurs de risque; les indications; les types d'hysterectomie realises et leurs complications rencontrees. Methodes: Il s'agit d'une etude retrospective des hysterectomies obstetricales realisees dans le service de Maternite du Centre Hospitalier Universitaire de Toamasina sur une periode de cinq ans; du 1er janvier 2005 au 31 decembre 2009. Resultats: Vingt-six cas d'hysterectomie obstetricale ont ete realises sur un nombre total de 13978 accouchements soit une frequence de 0;19. Les femmes les plus a risque etaient surtout celles agees entre 20 et 35ans (Odds Ratio = 12;27 ; IC a 95= 2;91 - 51;76; p=0;001) et les grandes multipares (Odds Ratio = 8;94 ; IC a 95= 2;14 - 37;32 ; p=0;001). La presence de suivi prenatal etait associee a un risque moindre (Odds Ratio = 0;2 ; IC a 95= 0;06 - 0;65 ; p=0; 01). L'indication etait dominee par les ruptures uterines (69) et les hemorragies de la delivrance (19). Une hysterectomie subtotale interannexielle a ete realise dans 81des cas. Les complications etaient surtout l'etat de choc (73); les infections (19); et les fistules vesico-vaginales (11;5). Le taux de mortalite maternel et foetal etait eleves; respectivement de 7;69et 81. Conclusion: Une meilleure prise en charge de la grossesse et de l'accouchement permettra de reduire les indications de l'hysterectomie obstetricale. D'autres techniques chirurgicales alternatives meritent d'etre largement diffusees

Post Partum Haemorhage among Women Delivered at Mbeya Referral Hospital in 2008

Objectives: To assess the prevalence; associated risk factors and outcome of post partum hemorrhage (PPH) among women delivering at the hospital setting. Design:Descriptive retrospective hospital based cross-section study RESULTS The targeted respondents were 344 pregnant women. Prevalence of PPH was 11.9with re-admission rate of 41.5and 12.2deaths secondary to PPH where most of the women (35.2) were given blood transfusion after re-admission and surgery as an immediate measure taken. Also it has been found that increase in blood loss is statistically associated with delivery by LSCS. (P=0.02) Risk factors for PPH found in this study are low hemoglobin (HB); pregnancy induced hypertension (PIH); trauma after delivery; history of birth before arrival (BBA); advanced age group (32years old) and multiparity ( 3 parity). Conclusion Although the prevalence seems to be low as compared to overall for Africa (33.4); still PPH is associated with high mortality (12.2) and morbidity where majority of risk factors found in this study are preventable

Active management of third stage of labour, post­partum haemorrhage and maternal death rate in the Vanga Health Zone, Province of Bandundu, Democratic Republic of the Congo

Background: Post-partum haemorrhage (PPH) is the single largest cause of maternal death worldwide and a particular burden for developing countries. In Africa, about 33.9 % of maternal deaths are due to PPH. In the Democratic Republic of the Congo (DRC), the prevalence of PPH is unknown. PPH can be prevented with active management of the third stage of labour (AMTSL). Objectives: To describe the practice of AMTSL in Vanga Health Zone and to calculate the incidence of PPH in Vanga Health Zone. Method: An intervention study with post-test-only design was conducted among health maternity wards using a data collection sheet to obtain information. All pregnant women attending Vanga Health maternity wards constituted the study population. Frequencies were determined for variables of interest. Results: From April 2007 to March 2008, 6339 deliveries took place at Vanga Health maternity wards, representing 71% of the institutional delivery rate. The number of deliveries realised with the practice of (AMTSL) were 5562; 366 cases of PPH were reported, making an incidence of 5.77%. Three cases of maternal deaths ­ two of which were related to PPH ­ were reported during the study period, which means there was a decline of 70% compared with the previous two years. Conclusion: The prevalence of PPH has been estimated to be 5.77%; PPH represents the cause of 67% of all maternal deaths. The extension of AMTSL practice, combined with the assurance of better supplies of oxytocin to enhance drug management, is strongly advised/suggested. As a number of births still take place outside the health maternity wards, the introduction of oral misoprostol could be considered a part of AMTSL for use by patients being treated by traditional midwives

Resultats de la suture de B-Lynch dans le traitement des hemorragies du post-partum

Objectif: Les hemorragies du post-partum constituent une urgence obstetricale majeure. Des techniques conservatrices uterines ont ete decrites avec succes pour controler ces hemorragies. Nous rapportons dans cette etude les resultats de la technique de capitonnage uterin selon B-Lynch dans le traitement des hemorragies du post-partum.Patientes et methodes: C'est une etude retrospective descriptive; realisee dans le Service de Gynecologie Obstetrique de Befelatanana; d'octobre 2008 a mai 2009. Elle concerne toutes les parturientes ayant presente une hemorragie du post-partum traitee chirurgicalement en utilisant la technique de B-Lynch. Resultats: Sept cas etaient enregistres dont cinq avaient accouche par cesarienne; ce qui representait 0;5des 976 cesariennes effectuees durant la periode d'etude. L'age moyen des parturientes etait de 24 ans. Cinq patientes sur sept etaient des primipares. L'atonie uterine etait la cause de l'hemorragie dans quatre cas et une anomalie de l'insertion placentaire dans trois cas. Chez six patientes; la technique de B-Lynch permettait d'arreter l'hemorragie et dans le dernier cas; nous avions du l'associer a une ligature vasculaire etagee. L'evolution etait favorable et aucune complication n'etait notee a huit mois de recul. Conclusion: La technique de B-Lynch est efficace; rapide et facile. Elle peut etre associee a d'autres procedures conservatrices pour controler les hemorragies du post-partum par atonie uterine ou anomalie d'insertion placentaire. Elle doit etre tentee avant de recourir a l'hysterectomie d'hemostase surtout chez les primipares

Prevention of postpartum hemorrhage: options for home births in rural Ethiopia

This paper sought to determine the safety and feasibility of home-based prophylaxis of postpartum hemorrhage (PPH) with misoprostol, including assessment of the need for referrals and additional interventions. In rural Tigray, Ethiopia, traditional birth attendants (TBAs) in intervention areas were trained to administer 600mcg of oral misoprostol. In non-intervention areas women were referred to the nearest health facility. Of the 966 vaginal deliveries attended by TBAs, only 8.9% of those who took misoprostol prophylactically (n=485) needed additional intervention due to excessive bleeding compared to 18.9% of those who did not take misoprostol (n=481).The experience of symptoms among those who used misoprostol can be considered of minor relevance and self-contained. This study found that prophylactic use of misoprostol in home births is a safe and feasible intervention. Community health care workers trained in its use can correctly and effectively administer misoprostol and be a champion in reducing PPH morbidity and mortality (Afr J Reprod Health 2009; 13[2]:87-95)