[Maternal and fetal outcomes of unattended pregnancies in Lubumbashi, Democratic Republic of Congo]. / Issues materno-fœtales des grossesses non suivies à Lubumbashi, République Démocratique du Congo.

INTRODUCTION: Unattended pregnancies are characterized by significant morbidity maternal and morbidity and mortality fetal. This study aims to determine the frequency of unattended pregnancies, to describe the socio-demographic profile and to assess the maternal and fetal outcomes during childbirth among women who did not attend antenatal care (ANC) in the city of Lubumbashi. METHODS: It was an analytical cross-sectional study of maternal pregnancy from December 2013 to May 2014 in 10 maternity hospitals in Lubumbashi. Women who did not receive ANC were compared to women who had followed them (ANC≥4). Maternal socio-demographic parameters, maternal and perinatal morbidity and mortality were analyzed. RESULTS: We found that the frequency of no pregnancy monitoring was 21.23% and the mean number of antenatal visits was 2.6 ± 1.9. An analysis of the relationship between ANC and socio-demographic characteristics of women who were delivered shows that the lack of follow-up was 2.29 times higher for adolescent girls than for adult women (OR=2.29 [1.54-3.41]), 4 times higher for women living alone than for women living in unions (OR=4.00 [2.05-7.79]) and 4.08 times higher for women with low levels of education (illiterate or primary) than among those with a high level of education (OR=4.08 [3.08-5.40]). Compared to those who followed them well, we did not find that women who did not attend ANC had a high risk of obstetric emergency (OR = 1.90 [1.26-2.95]), rupture of membranes fetal admission (OR=1.31 [1.02-1.68]), fetal mal presentation (OR=1.89 [1.03-3.44]), caesarean delivery (OR=1.78 [1.21-2.63]), eclampsia (OR=3.00 [1.09-8.70]), uterine rupture (OR=4.76 [1.00-47.19]) and anemia (OR=2.33 [1.06-5.13]). Rates of preterm birth (OR = 1.93 [1.33-2.80]), post-maturity (OR=1.47 [1.00-2.30]), low birth weight (OR=2.33 [1.56-3.46]), neonatal depression (OR=3.89 [2.52-6.02]), neonatal transfer (OR=1.60 [1.11-2.32]) and perinatal mortality (OR=2.70 [1.59-4.57]) were significantly higher in neonates from women with prenatal consultations than in those with well followed. CONCLUSION: Our study shows that the lack of follow-up of ANC is associated with high maternal morbidity and high perinatal morbidity and mortality in our environment.

[External anthropometric measurement and pelvimetry among nulliparous women in Lubumbashi: risk factors and predictive score of mechanical dystocia]. / Étude anthropométrique et pelvimétrique externe chez les nullipares de Lubumbashi: facteurs de risque et score prédictif de la dystocie mécanique.

INTRODUCTION: Maternal and perinatal morbi-mortality is higher in most of sub-Saharan Africa compared to the rest of the world. All women at risk for mechanical dystocia should be screened before labor and referred to a better equipped Hospital for childbirth. This would reduce morbi-mortality. This study aims to develop a predictive score of mechanical dystocia during childbirth among nulliparous Congolese women. METHODS: We conducted a cross-sectional study of nulliparous women with single pregnancy in 7 Maternity Units in the city of Lubumbashi (DRC). Women' size, weight, and external pelvimetry results were collected and analyzed. Univariate and multivariate analyses were performed. Discrimination score was assessed using the ROC curve. RESULTS: We included in the study 535 nulliparous women, of whom 126 (23.55%) had given birth by cesarean section due to mechanical dystocia. After logistic modelling, three criteria emerged as predictive factors for mechanical dystocia: maternal height <150 cm (adjusted OR=2.96 [1,49-5,87]), bi-ischiatic diameter <8 cm (adjusted OR =15.96 [3,46-73,56]), and Trillat's pre-pubic diameter <11 cm (adjusted OR =2.34 [1,36-4,01]). The area under the ROC curve of the score was 0.6549 with a sensitivity of 23.81%, a specificity of 97.80% and a positive predictive value of 76.92%. CONCLUSION: It has been observed that 10th percentile of the three maternal anthropometric measures was predictive of mechanical dystocia. When they were used together, these three values allowed for the development of lowest-cost screening score for use in low income settings.

[Fetal macrosomia in Lubumbashi: risk factors and maternal and perinatal prognosis]. / Macrosomie fœtale à Lubumbashi: facteurs de risque et pronostic maternel et périnatal.

INTRODUCTION: Fetal macrosomia is usually defined when the estimated fetal weight is greater than or equal to 4000 grams. The aim of this study was to determine the incidence of macrosomia, to identify its etiological factors and to evaluate maternal and perinatal prognosis. METHODS: This is a case-control study conducted in maternity units of 10 general referral hospitals in the city of Lubumbashi in Democratic Republic of Congo between 1 December 2013 and 31 March 2014. The post-partum women were divided into two groups according to their fetal birth weight: group I (≥4000 grams or more) and groups II (from 2500 to 3500 grams). Maternal characteristics, obstetrical environment as well as maternal and perinatal prognosis were studied and compared in the two groups. Data were analyzed using Epi Info 7.1 software. Differences were considered significant if p <0,05. RESULTS: A total of 668 mothers-newborns pairs were included in the study, 167 macrosoma and 501 controls. The incidence of fetal macrosomia was 5,7%. Compared to mothers from the control group, we found that mothers of macrosomic infants were older, multiparous, multigravidae, obese, diabetic and had previously delivered a macrosomic fetus. The rates of cesarean delivery and pathological delivery were significantly higher in mothers of macrosomic infants than in those of the control group. Male sex was significantly more prevalent among macrosomic infants than among the control group. Shoulder dystocia was recorded only in the macrosomic group. CONCLUSION: The prevalence of delivery of a macrosomic infant in Lubumbashi is 5,7%. Macrosomia is often the cause of maternal and perinatal complications. Reduction of maternal and perinatal complications passes through a better understanding of risk factors and an early detection.