Facteurs pronostiques des complications obstétricales en réanimation au Centre hospitalier universitaire de Cocody / Prognostic factors of obstetrical complications in intensive care at the university hospital of Cocody

Contexte. En dépit des progrès médicaux, les complications obstétricales occasionnent de nombreuses admissions en réanimation et sont des sources de létalité importante. L'objectif de cette étude était d'analyser les causes et les caractéristiques des décès secondaires à une complication obstétricale en réanimation. Méthodes. Etude prospective, descriptive et analytique sur vingt-quatre mois incluant toutes patientes admises en réanimation pour une complication obstétricale. Les paramètres épidémiologiques, cliniques et thérapeutiques ont été recueillis. Les comparaisons statistiques étaient basées sur le test de Fischer (p<0,05). Résultats. Nous avons colligés 153 dossiers sur 653 soit 23,543%. L'âge moyen était de 27,26 ± 7,43 ans. Le transport était non médicalisé dans 95,42% des cas. Les patientes provenaient du bloc opératoire pour 62,02% d'entre elles. Pour 81,70% d'entre elles, il n'y avait aucun antécédent et 56,21% étaient à moins de 37 SA. Le trouble de la conscience était le principal motif d'admission. La pathologie hypertensive et ses complications étaient le diagnostic le plus observé. Celles qui ont pu être transfusées représentaient 13/21 patientes soit 61,90%. L'intubation orotrachéale a concerné 9,15% des patientes. La létalité était de 39,87%. Cette dernière était observée surtout pendant la garde et avait lieu au bout de 48H. La tranche d'âge [31-45 ans], le long délai d'admission (≥ 2 jours), l'instabilité hémodynamique à l'admission, l'existence de complications, la garde sont des facteurs de mauvais pronostics (P<0,05). Conclusion. La mortalité maternelle demeure élevée. L'identifi cation des facteurs de mauvais pronostic devrait améliorer la prise en charge des patientes.

Stakeholders' perceived achievements and challenges after the safe motherhood project in Northern Uganda

The Japanese Red Cross Society (JRCS) and the Uganda Red Cross Society (URCS) implemented the Safe Motherhood project topromote mother-friendly society in northern Uganda from 2010 to 2016. The follow-up study has not been conducted and the information on achievements and challenges after the project were limited. To review the safe motherhood project in northern Uganda, the purpose of the study was to explore the stakeholders' perceived achievements and challenges after the project. Study design was qualitative content analysis using interview guides. After the approval of Institutional Review Board Clearance, the study was started (Approval Number: 2017-034). The subjects were informed about the ethical considerations (informed consent, participation on free will, confidentiality, and anonymity) in participating in the research, and they participated after signing the consent form. Six volunteers, 2 health center staff, and 2 former Uganda Red Cross staff were interviewed. Achievements were the acquisition of knowledge, attitudes changes, behavioural changes, linkage of all stakeholders, and positive influence on Safe Motherhood in community. Challenges of sociocultural barriers, attitudes toward women, accessibility and human resources, incentives and facilities, and sustainability of the project were derived from the interview. The study revealed that the project linked all stakeholders to achieve Safe Motherhood in community and all the developed registration systems were taken over. Long-term support is necessary for Safe Motherhood to take root

Kawasaki disease; rare; or misdiagnosed: A case report in a tertiary hospital in Nigeria

Kawasaki disease (KD) is a self-limiting, acute febrile vasculitis with predilection for children under-5 years. Most reports have emanated from Japan with only a few cases reported in Africa. KD presents a diagnostic dilemma and a high index of suspicion is critical as early treatment reduces the incidence of complications. We describe a 5-month-old male infant who presented with classical clinical features though with delayed diagnosis. Received moderate dose aspirin with limitation of access to intravenous immunoglobulin and who did not develop coronary artery complication. The case report highlights the diagnostic challenges faced by practitioners, made worse by the low index of suspicion inherent in our setting. The fatal complications that may be associated with KD can, therefore, be avoided. It is hoped that pediatricians in particular would become conversant with the diagnostic criteria to facilitate early diagnosis and intervention in children

Incidence and determinants of stillbirth among women who gave birth in Jimma University specialized hospital, Ethiopia

Introduction: worldwide approximately 2.7 million are stillborn, more than 98% of these occur in developing countries. To address the problem, incidence and determinants of stillbirth must be understood. Therefore the aim of this study was to assess incidence and determinants of stillbirth among women who gave birth in Jimma University specialized hospital.Methods: a cross-sectional study design among 413 mothers who gave birth in Jimma specialized hospital was employed. Study subjects were selected by systematic sampling technique from the list of women who gave birth in hospital in one month study period. Data were collected by using pretested and structured questionnaire. Data were edited, cleaned, coded, entered and analyzed using SPSS-20 statistical software. Univarate and bivariate (logistic regressions) analysis was employed.Results: the incidence rate of stillbirth in the Hospital during a month period was 8% or 80 per 1000 total births. The predictors that showed an independent close association with stillbirth were absence of complication (OR = 0.1, 95% CI (0.04-0.2)), referral from other health facility (OR = 0.3, 95% CI (0.1-0.7)), having antenatal care (OR = 0.3, 95% CI (0.1-0.7)) and normal vaginal delivery (OR = 0.2, 95% CI ( 0.1-0.8)). Conclusion: the incidence rate of stillbirths in our setting is high and the identified determinants were related to both ante-partum and intra-partum-period. Therefore, effort should be made to improve antenatal, obstetric services and delivery services in terms awareness, access, timing and referral system to emergency care and specialized service to reduce the number of stillbirths

Profile of delivering mothers in Lubumbashi, Democratic Republic of the Congo

The aim of our study was to establish an inventory of deliveries in Lubumbashi, Democratic Republic of Congo. We carried out a descriptive study in 10 General Reference Hospitals in the city from 1 December 2013 to 31 May 2014. The study reports that pregnant mothers in Lubumbashi deliver at a mean age of 28.2 years. The women have a mean parity of 3.8, they are married (97.7%), overweight (mean BMI 25.68 kg/m2) and had 2.6 antenatal care on mean. The primary mode of delivery was spontaneous vaginal delivery (91.7%). About 10% of mothers had a complication dominated by perineal or vaginal tears and haemorrhagic complications. Newborns weighed on average 3121.2 grams and 0.56% had a congenital malformation dominated by polydactyly and cleft-palate. Maternal and perinatal mortality rates were 310 per 100,000 live births and 42.4 per 1,000 live births, respectively

Risk factors and perinatal outcome of umbilical cord prolapse in Sagamu, Nigeria

Background: Umbilical cord prolapse is an obstetric emergency that threatens the life and well-being of the fetus and also increases maternal morbidity. Fetal survival in umbilical cord prolapse can be enhanced by prevention where risk factors are identified and prompt diagnosis and decisive intervention.Objective: The aim of this study was to determine the incidence, identify the risk factors associated with umbilical cord prolapse and document the perinatal outcome of cases of cord prolapse.Methods: This was a 13-year retrospective case-control study of cases of umbilical cord prolapse seen at the OOUTH, Sagamu, Southwestern Nigeria between January 1, 2000 and December 31, 2012.Result: During the study period, the incidence of umbilical cord prolapse was 1 in 122 deliveries (0.82%). The umbilical cord prolapse occurred in association with breech presentation five times (33.3%) and transverse lie eleven times (18.5%). The occurrence of breech presentation among the control cases was 8.6% (p<0.001) and that of transverse lie was 1.9% (p<0.001). There were also significant statistical differences between the cases of cord prolapse and controls in terms of prematurity, low birth weight, unbooked status and multiparity. The perinatal rate was 222/1000 (22.2%) compared to the perinatal mortality of 68/1000 (6.8%) for the control group.Conclusion: It is suggested that pregnant women should be encouraged to register early in pregnancy for antenatal care as this will enhance early identification of the risk factors and appropriate management instituted to reduce perinatal mortality

Prevalence and outcome of pregnancy among elderly primigravida in Aminu Kano teaching hospital, Kano: a 5 year review

Background: As women increasingly delay child bearing, the proportion of women having their first delivery at ''advanced maternal age'' is expected to rise. These elderly primigravidae have traditionally been considered to be at increased risk of adverse maternal and perinatal outcomes compared to their younger counterparts, because of associated pregnancy and labour complications. Objectives: To determine the prevalence of elderly primigravidae and compare their pregnancy outcome with that of younger primigravidae in Aminu Kano Teaching Hospital, Kano. Materials And Methods: This was a retrospective case control study comparing the pregnancy outcome of primigravid mothers aged 35 years and above (elderly primigravidae) with those of younger primigravidae aged 20-25 years, who delivered at Aminu Kano Teaching Hospital between January 2009 and December 2013. Results: There were 18,452 deliveries during the period under review, out of which 295 were primigravidae aged 35 years or above giving a prevalence of 1.6%. There was statistically significant higher preterm delivery rate ( X2= 10.30, P= 0.001) and caesarean delivery rate (X2= 12.15, P= 0.0001) among the elderly primigravidae compared to younger primigravidae. The elderly primigravidae were more prone to hypertensive disorders in pregnancy (X2=23.96, P=0.0001) and diabetes (X2=4.689, P=0.030) compared to the younger primigravidae. The prevalence of antepartum haemorrhage (X2=6.434, P=0.011) and uterine fibroids (X2=5.549, P=0.019) were also statistically significant among the elderly primigravidae compared to the younger primigravidae. There was no significant difference in the other maternal and foetal outcome measures. Conclusion: The prevalence of elderly primigravidae in this study was 1.6%. The prevalence of obstetric complications such as preterm delivery, antepartum haemorrhage, uterine fibroids coexisting with pregnancy and medical conditions like hypertensive disorders in pregnancy and diabetes mellitus are higher among elderly primigravidae compared to younger primigravidae. The elderly primigravidae were also more liable to have caesarean deliveries than the younger primigravidae. However there was no difference in the fetal outcome in the two groups

Birth preparedness, complication readiness and fathers' participation in maternity care in a northern nigerian community

The role of men in maternity care in Africa is understudied, despite their economic dominance and decision making power. In a patriarchal society like northern Nigeria, pregnancy and childbirth are often regarded as exclusively women's affairs. Using data from interviewer administered questionnaires and in-depth interviews; we assessed birth preparedness, complication readiness and male participation in maternity care in Ungogo, a northern Nigerian community. Majority of pregnancies were unplanned (96%). Only 32.1% of men ever accompanied their spouses for maternity care. There was very little preparation for skilled assistance during delivery (6.2%), savings for emergencies (19.5%) or transportation during labour (24.2%). Young paternal age (adjusted odds ratio [AOR] =1.5, 95% confidence interval [CI]=1.2-2.6), formal education (AOR=1.9, 95%CI=1.1-3.4) and non-Hausa Fulani ethnicity (AOR=2.3, 95%CI=1.4-3.3) were independent predictors of male participation in maternity care. There is a need to increase involvement of men in their partner's maternity care through peer-led, culturally-sensitive community education and appropriate health system reforms (Afr J Reprod Health 2010; 14[1]:21-32)

Knowledge and utilization of the partograph among obstetric care givers in South West Nigeria

This cross-sectional study assessed knowledge and utilization of the partograph among health care workers in southwestern Nigeria. Respondents were selected by multi-stage sampling method from primary; secondary and tertiary level care. 719 respondents comprising of CHEWS - 110 (15.3); Auxiliary Nurses - 148 (20.6); Nurse/Midwives - 365 (50.6); Physicians - 96 (13.4) were selected from primary (38.2); secondary (39.1) and tertiary levels (22.7). Only 32.3used the partograph to monitor women in labour. Partograph use was reported significantly more frequently by respondents in tertiary level compared with respondents from primary/secondary levels of care (82.4vs. 19.3; X2 = 214.6; p 0.0001). Only 37.3of respondents who were predominantly from the tertiary level of care could correctly mention at least one component of the partograph (X2 = 139.1; p 0.0001). The partograph is utilized mainly in tertiary health facilities; knowledge about the partograph is poor. Though affordable; the partograph is commonly not used to monitor the Nigerian woman in labour

Evaluation of criteria-based clinical audit in improving quality of obstetric care in a developing country hospital

Study evaluated criteria­based clinical audit in measuring and improving quality of obstetric care for five life-threatening obstetric complications: obstetric haemorrhage, eclampsia, genital tract infections, obstructed labor and uterine rupture. Clinical management of 65 patients was audited using a 'before (Phase I) and after (Phase II)' audit cycle design using standard criteria. Following Phase I, areas in need of improvement were identified; mechanisms for improving quality of care were identified and implemented. Overall care of the complications improved significantly in obstetric haemorrhage (61 to 81%, p = 0.000), eclampsia (54.3 to 90%, p=0.00), obstructed labour (81.7 to 93.5%, p<0.001) and genital tract sepsis (66 to 85.2%, p < 0.01). Clinical monitoring, drug use, and urgent attention by senior medial staff also improved significantly after intervention. Criteria-based clinical audit is feasible and acceptable for improving management of life-threatening obstetric complications. Its application is recommended in health institutions in developing countries (Afr J Reprod Health 2008; 12[3]:59-70)

A medical birth registry at kilimanjaro Christian Medical Centre

Objective: To establish a medical birth registry intended to serve clinical; administrative and research purposes. Methods: Starting in July 2000; every birth at Kilimanjaro Christian Medical Centre (KCMC) in Moshi; Tanzania has been recorded in a separate database. The information is obtained through personal interviews with each mother; conducted by specially trained midwives; and supplied with data from the medical records. A secretary enters the data into the electronic file. Data are collected about the mother and father: education; occupation and living conditions; mother's health before and during present pregnancy; expected date of delivery; smoking and drinking (alcohol) habits; use of drugs; plus HIV and syphilis status (if known). This is followed by particulars on the delivery: spontaneous or induced; and complications; the child or children: weight; height and Apgar score; malformations and other diagnoses. Mode of birth: spontaneous or operative intervention. If perinatal death: when? Transfer to intensive neonatal unit? The mother's reproductive history (births; miscarriages; ectopic pregnancies) is also recorded; with outcomes. Results: We describe the process based on more than six years' experience; including obstacles and how they were overcome. The registry serves as a monitoring tool; with a set of key activities and events being issued monthly; indicating changes and trends in; e.g.; bleeding complications; caesarean section rates and perinatal mortality; as early warning signs. Monthly reports on key issues are presented. Confidentiality and data protection are key issues. Day-to-day recording of births is vulnerable to personnel shortage; whether from disease or holidays.Conclusions: Validation and quality checks leave the overall impression that the database is largely accurate and credible. There are plenty of opportunities for research. Clinicians and epidemiologists will profit

Obstetric problems: a manual

This manual has been written for those in Malawi who deal with obstetric problems at the hospital level: state registered nurses-midwives; clinical officers; and doctors. It assumes a basic training in obstetrics and some practical experience of obstetric problems as well. It is not a book for beginners