Tendance de la mortalité maternelle au Centre Hospitalo-Universitaire de Constantine entre 2012 et 2017 / Trend in maternal mortality at Constantine University Hospital between 2012 and 2017

Contexte et objectifs. Les données sur la tendance de la mortalité maternelle sont fragmentaires en Afrique Subsaharienne. La présente étude avait pour objectif de faire une analyse triennale de l'évolution du taux de mortalité maternelle et identifier les causes de décès. Méthodes : Il s'agissait d'une étude observationnelle documentaire, sur la mortalité maternelle enregistrée ; au Centre hospitalo universitaire de Constantine, entre le 1er Janvier 2012 et le 31 Décembre 2017. Résultats. Soixante-dix décès maternels ont été déplorés. Le taux de mortalité maternelle est de 101,3 décès pour 100 000 naissances vivantes. Les hémorragies obstétricales et les complications hypertensives de la grossesse sont les premières causes de mortalité. L'analyse des données triennales met en évidence une baisse importante de la mortalité par hémorragie et par complications de l'anesthésie. Conclusion. Cette étude a permis de dresser un profil des causes de la mortalité maternelle dont les niveaux restent inquiétants et requièrent une action globale.

Pattern of liver enzymes and maternal outcome in eclamptic patients admitted to the Intensive Care Unit, University College Hospital, Nigeria

Introduction: Eclampsia, a hypertensive disorder, is one of the leading causes of maternal mortality in developing countries like Nigeria. We evaluated the relationship between the pattern of liver enzymes and maternal mortality in eclamptic women. Method: A retrospective study of 55 eclamptic women admitted to the Intensive Care Unit (ICU), University College Hospital, Nigeria, was conducted. Data were obtained on their demographic, obstetric, and clinical characteristics, liver enzyme patterns, and maternal outcome. Analysis was by descriptive statistics, univariate analysis, and non-parametric tests with level of significance set at p<0.05. Results: Maternal deaths occurred in 27.3% and elevation of liver enzymes was observed more among the dead patients compared with those who survived. Alanine aminotransferase (ALT) was the most commonly elevated liver enzyme, occurring in almost all (90.9%) the patients. Maternal mortality was significantly associated with age (p=0.001), saturated oxygen levels (p=0.007), elevated alkaline phosphatase (p=0.008), alanine aminotransferase (p=0.013), aspartate aminotransferase (p=0.016), and total bilirubin (p<0.001). Conclusion: Maternal mortality due to eclampsia was clinically associated with age, elevated liver enzymes and a lower serum level of total bilirubin. Liver transaminases are therefore important prognostic indicators associated with eclampsia.

Aspects cliniques et évolutifs de la pré-éclampsie sévère traitée à la maternité Befelatanana, Madagascar / Clinical aspects and outcome of severe pre-eclampsia treated at the Befelatanana maternity hospital, Madagascar

Pre-eclampsia is a major public health problem and is one of the main causes of maternal-fetal morbidity. The main objective of this study is to describe the clinical and evolutionary aspects of severe pre-eclampsia. Methods: This was a retrospective, monocentric, descriptive, observational and cross-sectional study of 6 months, from January 01, 2019 to June 30, 2019, conducted at the level of the resuscitation service of the university hospital of gynecology obstetrics Befelatanana (CHU GOB). Results: Three hundred and fourteen (5.10%) cases out of 6153 admissions of severe pre-eclampsia were collected in the study; the average age was 27.29 ±7.47 years. Eclampsia (30.25%, n= 95), retroplacental hematoma (13.38%, n= 42) and acute renal failure (7.96%, n= 25) were the most frequent maternal complications. Maternal prognosis was favorable in 92.36% of cases (n= 290). Maternal death represented 3.18% (n= 10). Prematurity (44.82%, n= 95), fetal hypotrophy (37.26%, n= 79) and fetal asphyxia (14.15%, n= 30) were the most common fetal complications. Fetal death was 26.47% (n= 81). Conclusion: It is necessary to reinforce the information and education of parturients on the first signs for an early detection, diagnosis and management

Access, perceived quality and uptake of antenatal services in urban communities of Osun state, Southwest Nigeria

Quality antenatal care (ANC) is one of the key interventions to improve intrapartum care uptakes and to reduce the menace of maternal deaths globally. Yet, ANC coverage has remained low in many developing countries like Nigeria. It becomes imperative to contextually understand factors associated with ANC uptake in Nigeria. The study assessed level of utilization, perceived quality, level of satisfaction and determinants of ANC utilization among women of reproductive age-group in Oshogbo, South-west Nigeria. Cross-sectional study design was employed and cluster sampling method was used to recruit 420 consenting respondents. Data were collected using pretested interviewer-administered, semi-structured questionnaire. Both descriptive and inferential statistics were done at p<0.05. The mean (±SD) age of the respondents was 30.84±6.0 years. Almost three-quarters (73.9%) of the respondents had at least 4 ANC visits. Main reasons for non-ANC usage were high cost of care, long waiting time at the clinic, long distance to the clinic and unsatisfactory service quality. Only 59.9% of respondents were satisfied with services received while 63.1% of them rated the service quality as excellent. Main determinants of ANC uptake were respondents' age (AOR=2.35;95%CI=1.34-5.89), level of education (AOR=0.56;95% CI= 0.42-0.71), socio-economic status (AOR=5.22; 95%CI=2.02-6.65) and monthly family income (AOR=0.89; 95%CI=0.02-0.90). Although the rate of ANC use was high in the study setting, the proportion of women who were satisfied with service quality was sub-optimal. There is need for implementation of multi-pronged intervention to make ANC services more available, accessible, affordable and acceptable to the Nigerian women

Maternal micronutrient status as a risk factor for perinatal mortality in a Tanzanian randomized controlled trial

The objective of this study was to determine if maternal micronutrient status (specifically iron) during pregnancy is a risk factor for perinatal mortality among women in Tanzania. Secondary analysis of data from a randomized, double-blind, placebo-controlled vitamin A supplementation trial conducted between August 2010-March 2013 was used to assess iron intake among women who experienced a stillbirth or early neonatal death. The mean dietary iron intake (measured using a quantitative Food Frequency Questionnaire) for this population was 12.64 mg/day (SD = 6.32). There were 206 cases of perinatal mortality. Three classifications of dietary iron intake were devised and risk ratios were calculated using the Log Binomial Regression Model: <18 mg/day (RR: 2.13), 18-27 mg/day (RR: 2.63), & >27 mg/day (the reference group to which the first two classification groups were compared).There was neither a significant relationship found among women who consumed iron levels <18 mg/day or between 18-27 mg/day of iron compared to women who consumed more than 27 mg/day of iron, but on average there was twice the risk for perinatalmortality. The current study is consistent with previous literature findings and supports the need for more efficacious nutrition strategies. (Afr J Reprod Health 2022; 26[7]: 38-48).

Women's experiences and perceptions on the impacts of maternal near miss and related complications in Rwanda: A qualitative study

Maternal morbidity and mortality continue to emerge across the globe especially in lower-income countries. This study aimed at exploring in-depth perceptions of near-miss experiences among Rwandan women and how these experiences can be used to develop strategies for health policy implementation. Using qualitative inductive research based on grounded theory, we analyzed 27 indepth interviews that were conducted with women with documented records of maternal near-miss events. Women were knowledgeable about pregnancy complications and the benefits of antenatal care. Near-miss events that occurred either before or during hospitalization. Women recognized their own involvement their near-miss events by delaying care seeking. They also mentioned delays due to healthcare providers delaying transfers, misdiagnosing the events, and delaying to intervene even at the time the diagnosis was made. Women acknowledged the life-saving role of outreach programs and community health workers. We that pregnancy outcomes would be improved in this population of women with education on pregnancy complications, training of community health workers, and sustained mentorship program. (Afr J Reprod Health 2022; 26[5]: 63-71).

Magnitude of preeclampsia and associated factors among women attending delivery service in Debre Tabor Specialized Hospital

BACKGROUND: Preeclampsia is among the leading causes of maternal and perinatal morbidity and mortality, and it continues as a global health concern. Therefore, this study was aimed to assess the magnitude of pre-eclampsia and its determinant factors among women attending delivery services in Debre Tabor Comprehensive Specialized Hospital Northwest Ethiopia. METHODS: Institutional-based cross-sectional study was conducted among 261 women from January 1- 30, 2021. A systematic sampling technique was applied. Data were collected using a structured and pre-tested questionnaire. The collected data were entered using Epi-data version 4.2 and analyzed by statistical package for social science (SPSS) version 23. A significant association was declared at a p-value of < 0.05 with a 95% Confidence interval. RESULTS: Overall 15,7% of women had preeclampsia. Age at menarche (10-15 years) (AOR=4.79; 95% CI: 2.07-15.27), unwanted pregnancy (AOR:1.29; 95% CI: 1.59-8.44), history of chronic hypertension (AOR:2.93; 95% CI: 1.00-6.20), BMI ≥ 30 Kg/m2 (AOR:1.79; 95% CI: 1.06-3.65), and alcohol consumption (AOR:2.12; 95% CI: 4.00-14.14) were significantly associated with preeclampsia. CONCLUSION: This study showed that the magnitude of preeclampsia was significantly high compared with previous national reports. Early menarche age, the status of current pregnancies, history of chronic hypertension, BMI, and alcohol consumption were significantly associated with preeclampsia. Therefore, the government and respective stakeholders should be strengthening antenatal care services to early identify and manage women with preeclampsia. Besides, health education and promotion should be strengthened regarding the maintenance of appropriate body weight and alcohol intake before pregnancy

Maternal deaths due to eclampsia in teenagers: lessons from assessment of maternal deaths in South Africa

Background: Eclampsia remains a major cause of maternal mortality, particularly in teenage pregnancies. Healthcare professionals providing antenatal must regard teenagers as a high risk group for the pre-eclampsia-eclampsia syndrome. Setting: Data extracted from the South African Saving Mothers Report: 2014­2016. Aim: To establish the clinical details in teenage maternal deaths owing to eclampsia. Method: Retrospective review of the case records and maternal death assessment forms of teenagers that died due to eclampsia during 2014­2016. Results: There were 47 teenagers (aged 14 to 19 years) who died from eclampsia. Of these 18 out of 47 (38%) deaths occurred in the post-partum period. Forty (85.1%) of the patients had antenatal care. Three (6.4%) had post-partum eclampsia, and of the remaining 44 of the 47 (93.6%), the gestational age at first occurrence of a seizure ranged from 25 to 39 weeks. The blood pressures at the time of seizure ranged from systolic of 131 to 210 mmHg and diastolic of 89 to 130 mmHg. The commonest final causes of death were intracerebral haemorrhage associated with severe hypertension and multi-organ failure. Avoidable factors included transport delays, referral to the wrong levels of health care and poor care by health professionals. Conclusion: Teenage pregnancy is a risk factor for eclampsia-related death; awareness of borderline elevations of blood pressure levels from baseline values (prehypertension levels) and taking following national guidelines on the management of hypertensive disorders of pregnancy will decrease deaths from eclampsia

Medico-social characteristics of patients with eclampsia in a metropolitan hospital in North western Nigeria: is there a changing pattern?

Background: Eclampsia is a recognized cause of maternal and neonatal morbidity and mortality in North western Nigeria. It's a preventable obstetrics calamity were adequate antenatal care services are provided. Objective: To review medico-social characteristics of patients with eclampsia at a metropolitan Specialist Hospital in North-western Nigeria. Methodology: Eighty consecutive patients that presented with eclampsia at Murtala Mohammed Specialist Hospital were recruited for the study from 1st December, 2016 to 28th February, 2017. Data were collected using structured questionnaire, administered by research assistants. Information obtained included sociodemographic data, duration of fits before presentation and maternal-fetal outcome. Results: A total of 1931 patients delivered within the study period, among them 80 had eclampsia. This gives an incidence of 4.0%. Teenage pregnancy accounted for 35%. Forty-nine patients (61.2%) were primigravidae and up to 95% were booked. Majority of the patients 40(50%) had antepartum eclampsia while only 10(12.5%) had postpartum eclampsia. Most of the patients (73.8%) presented within 12 hours of convulsions and (87%) had vaginal delivery. There were 3 maternal deaths with case fatality rate of 3.8%. Live birth was achieved in 65%. Fresh still birth and Macerated still births were recorded in 20% and 12.5% respectively. Conclusion: The incidence of eclampsia is still high despite introduction of free maternity care services. Socio medical factors and poor quality of Antenatal Care services may be the contributing factors to development of eclampsia. There is need to review and improve the quality of antenatal care services offered at the primary health care centers

Pratique de l'anesthésie générale lors de la césarienne au Centre hospitalier

Contexte et objectif. L?anesthésie générale en obstétrique est une anesthésie difficile à cause des modifications physiologiques liées à la grossesse. Ces modifications augmentent le risque morbidité et de mortalité maternelle surtout à causes des difficultés de la gestion des voies aériennes. En plus l?anesthésie générale compromet l?adaptation du nouveau-né à la vie extra-utérine. Ainsi elle a des indications précises et codifiées en particulier les urgences extrêmes (1, 2, 3, 4,5). Cette étude a été menée dans l?objectif de vérifier la conformité des indications de l?anesthésie générale pour césarienne.Méthodes. Il s?est agi d?une étude documentaire réalisée pendant la période allant de janvier 2011 à décembre 2016 au Centre Hospitalier de Monkole. Elle a porté sur toutes les césariennes pratiquées durant cette période. Les variables recherchées ont été : l?âge des femmes césarisées, l?IMC, la parité ; l?âge de la grossesse, le suivi de CPN, l?indication de la césarienne, le degré d?urgence, la classe ASA et sa justification, les motifs et les modalités de réalisation de l?anesthésie générale, les difficultés d?intubation, les incidents per opératoires, les complications postopératoires et l?issu foeto-maternel.Résultats. Sur 980 césariennes réalisées pendant cette période, 53 soit 5,4% ont été faites sous anesthésie générale. L?âge moyen des femmes est de 30,41 ans avec des extrêmes de 17 et 42 ans. L?IMC moyen est de 21,66Kg/m2 avec des extrêmes allant de 17,4 et 36,9. Les paucipares étaient majoritaires avec 33,96%. La grossesse était à terme dans 66,03%, prématurée dans 30,18% et post-terme dans 3,77%. 60,4% des femmes n?avaient pas suivi les CPN ou les avaient suivies en dehors de Monkole. Les indications de la césariennes étaient maternelles (41,5%), annexielles (43,39%), foetales 11,3% et mixte (3,77%). La césarienne était urgente dans 46 cas soit 86,8%. La classe ASA était III (37,73%) ; I (26,4%) II (22,64% et IV (13,2%). La justification de l?ASA était : choc hémorragique : 20,75%, anémie modérée : 15,9% ; anémie sévère : 13,2% ; prééclampsie sévère : 18,88% dont 13,2% d?éclampsie ; obésité : 7,54 et péricardite : 1,88%. Les scores de Mallampati étaient I dans 72,2%, II dans 16,98%, III dans 3,77% alors les scores de Cormak et Lehane étaient de I dans 83,01% et II dans 16,98%. L?anesthésie générale a été indiquée d?emblée chez 36 femmes soit 67,9% et par conversion de l?ALR dans 32,1%. Le motif de la conversion était l?anxiété dans 7 cas, l?échec de l?ALR dans 4 cas, l?hémorragie dans 3 cas, le bloc insuffisant dans 2 cas et le vomissement avec désaturation dans un cas. 47 femmes ont été intubé selon la technique d?induction à séquence rapide ; 6 avec le propofol seul sans curare (conversion), le taux de réussite de l?intubation était de 100%. L?induction a été faite avec le propofol 60,37%, kétamine 33,97% et propofol plus kétamine 3,77%. L?entretien a été assuré avec l?isoflurane dans 79,24%, la kétamine dans 13,2% et le propofol dans 4%. Le fentanyl (31%) et le sufentanil (16%) ont été donné après clampage du cordon et dans 11,3% aucun morphinique n?a été utilisé à cause de la certitude du bloc rachidien. Le curare non dépolarisant (pancuronium) a été utilisé en entretien chez 18,86% des femmes. 51 femmes soit 96.2% ont été extubées sur table, une à la quatrième heure et une jamais. Les incidents peropératoires anesthésiques ont été l?hypotension dans 6 cas, la désaturation dans un cas les incidents chirurgicaux/obstétricaux ont été l?hémorragie dans 3 cas et l?atonie dans un cas. Les complications postopératoires étaient : 3 cas d?anémie décompensées un cas chacun pour la ligature des uretères, l?éclampsie du postpartum, l?hématome avec fistule vésico-vaginale et la fistule stercorale. Il ya eu un décès maternel par hémorragie incontrôlable chez une femme ayant un placenta praevia percreta érodant la vessie. 15 foetus soit 28,3% étaient mort-nés, 23 soit 43% aveint un bon APGAR à la première minute, 15 soit 28,03% avaient un APGAR faible mais ont été récupérés après réanimation.Conclusion. La pratique de l?anesthésie générale pour césarienne au centre hospitalier Monkole répond globalement aux recommandations internationales probablement à cause de la présence permanente des médecins spécialistes. Une étude analytique et surtout multicentrique nous semble nécessaire pour faire l?état de lieux de la pratique dans la ville de Kinshasa et pourquoi pas sur l?étendue du territoire national