Post-operative maternal morbidity and mortality after caesarean delivery and laparotomy for uterine rupture at the gynecology and obstetrics service of the Ignace Deen National Hospital in Guinea
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20204782Keywords:
Morbidity, Maternal mortality, Post-operative, Caesarean delivery, Uterine rupture, Ignace DeenAbstract
Background: The aim of the work was to study post-operative maternal morbidity and mortality after caesarean delivery and laparotomy for uterine failure, to describe the main causes and to analyze the risk factors.
Methods: It was a descriptive, comparative and analytical study lasting 2 years with data collection in 2 phases, one of which was a retrospective study lasting one year from July 2018 to June 2019 and the other a prospective study also lasting one year, from July 2019 to June 2020. It concerned all pregnant women who had been caesarized or had had a laparotomy for uterine rupture with complications and those who had not developed any complications. The parameters studied were types of complications, risk factors and maternal mortality. The Chi-square test was used to compare the two populations with a significance level p=0.05.
Results: During the study period, 6141 hospitalizations were recorded among which 5682 surgical procedures were performed, i.e. 92.52% of hospitalizations. Caesarean delivery accounted for 90.55% of surgical procedures and laparotomy for uterine rupture for 1.10%. The overall maternal post-operative morbidity rate was 7.60%. Post-operative anemia was by far the most common complication (75.76%) followed by infection (23.46%). The maternal death rate was 0.92% with a ratio of 409.97 maternal deaths per 100,000 live births and more than 2/3 of these deaths were due to caesarean delivery. Anemia and septic shock were the main causes of death. Factors related to this post-operative maternal morbidity were: age greater than or equal to 40 years, multi-parity, illiteracy, emergency obstetric evacuation, low socio-economic level, poor quality of prenatal follow-up and rupture of membranes before admission.
Conclusion: In the emergency context concerning majority of our cesarean deliveries and the totality of uterine ruptures predispose the mother to high significant morbidity and mortality.
References
Robitol S, Gode S, Barran K, Tremouille S, Belec M. What is the cost of a Caesarean delivery in Madagascar? Socio-demographic aspects and Caesarean delivery coverage rate in Toamacina 1999-2007. Pub Health. 2003;274-9.
WHO: World Health Statistics. 2011;170:15. Accessed on 20 July, 2020.
Demographic and Health Survey (EDS V) Guinea 2018. National Institute of Statistics. The DHS program, ICF. Rockville, Maryland, USA. 2019:151-78. Accessed on 20 July, 2020.
Akotionga M, Sawadogo Y, Lankoandé J, Koné B. Postoperative maternal morbidity and mortality in an African environment. About 583 cases of EP, Caesarean deliveries and uterine ruptures at the National Hospital Center of Ouagadougou. Rev Fr Gynaecol Obstetrics. 1999;94(6):460-6.
Pambou O, Guyot B, Antoine JM, Salat Baroun. Gynecological endoscopic surgery in Africa: luxury or necessity? Rev Fr Gynecol Obstet. 1990;90:174-7.
Baldé IS, Sy T, Diallo MC, Diallo Y, Soumah FM, Diallo A, et al. Maternal complications after Caesarean delivery at the Gynecology-Obstetrics Department.Anales de la SOGGO. 2008;11(3):170-5.
Touré, Coulibaly K Anongba S, Aissi GA. Indications for Caesarean delivery. About 754 cases collected at the maternity hospital of Treichville. Communication of the 3rd congress of the SAGO, Abidjan 1996.
Diawara A, Sangho H, Tangara I, Cissé MO, Traoré MN, Konaté S. Post-caesarean delivery complications and free caesarean delivery in Mali: the case of a district health centre. Mali médical. 2014;(1)45-9.
Diallo MH, Baldé IS, Mamy MN, Diallo BS, Baldé O, Barry AB, Keita N. Uterine rupture: sociodemographic aspect, etiology and management. Med Santé Trop. 2017;27:305-9.
Talle B. Maternal post-caesarean delivery complications (about 828 caesarean deliverys performed in 1999 in the maternity ward of the Treicheville University Hospital. CES dissertation. Gynecol Obstét. 2000;596.
Ham VM, Van Dogen PW, Mulder J. Matrenal consequences of caesarean delivery. A retrospective study of intra operative and prospective maternal complications of ceasarean delivery during a 10 years period. Eur J Obstet Gynecol Biol. 1997;74:1-6.
Boulanger JC, Vist M, Berh VB, Cauner B, Caron C, Firmin JM. Maternal complications of caesarean deliveries. J Gynécol Obstét Biol Repro. 1986;15:327.
