Epidemiology of Maternal Deaths from 2017 to 2022 in the Obstetrics and Gynaecology Department of the University Hospital of Tengandogo, Burkina Faso

Background: Although maternal mortality is declining in most countries, it remains a significant public health problem worldwide, with high rates, particularly in developing and insecure countries like ours. Objective: To study the epidemiological factors and factors associated with the occurrence of maternal death in the Gynecology-Obstetrics Department of University Hospital of Tengandogo. Method: It was a retrospective case-control study with a descriptive and analytical purpose over a period of 6 years from January 1, 2017 to December 31, 2022. Cases were women with maternal deaths during the study period. Data processing and analysis were performed using Stata version 13 software. Univariate and multivariate analyses were performed with Stata version 13 software, and logistic regression modeling was used to estimate crude and adjusted odds ratios (OR), their 95% confidence intervals (CI), and the threshold for statistical significance was set at a p value < 0.05. Results: A total of 372 patients were included in the study, including 146 cases of maternal death. The in-hospital maternal mortality rate was 1933 deaths per 100,000 live births. The average age was 28.5 years. 58.9% of patients lived in rural areas. Married patients accounted for 88.7% of cases. The average parity was 3. Direct obstetrical causes were the main causes of death, accounting for 72.6%. They were dominated by post-partum hemorrhage (24.2%), puerperal infection (18.6%), pre-eclampsia/eclampsia (16.1%) and retroplacental hematoma (8.9%). Chronic anemia (12.9%) was the main indirect obstetric cause. Risk factors associated with maternal death were primiparity (OR for paucigravida and multigravida at 0.05;P = 0.001);ambulance transport (OR for patients referred and brought in by personal vehicle = 0.3, p < 0.001) and vaginal delivery (OR for cesarean deliveries = 0.4, p < 0.001). Conclusion: To reduce maternal mortality in Burkina Faso, strategies such as educating women about danger signs during pregnancy and promoting women’s education can be adopted.

Epidemiological, Clinical, Therapeutic and Prognostic Aspects of Puerperal Infections within the Gynecology Obstetrics Department of Yalgado Ouedraogo University Teaching Hospital (CHU-YO), Burkina Faso

Objective: Conduct a study about the epidemiological, clinical, therapeutic and prognostic aspects of puerperal infections within Gynecology Obstetrics department of CHU-YO during the study period. Patients and Methods: This was a cross-sectional and descriptive study. The study period was from January 1st to December 31st, 2019. Data collection was retrospective. The exhaustive sample included all female patients having a puerperal infection. Results: Our study included 65 patients. The frequency of puerperal infections represented 1% of deliveries, the average age of patients was 27 ± 7.26 years. Housewives represented 64.4% of the patients. Hyperthermia and abdominal-pelvic pain respectively occurred in 63.8% and 21.3% of patients. The patients had given birth by caesarean section in 83.1% of cases. Endometritis represented 76.9% of cases of puerperal infections. The patients were treated with antibiotics, uterotonics and symptomatic therapy. Maternal death occurred in 13.9% of cases. Conclusion: A focus should be put on preventive measures in front of any high-risk puerperal infection situation.

Cesarean Section Indications and Prognosis in Adolescents Girls at the Mother-Child Pool of the Teaching Hospital of Tengandogo (CHU-T) in Burkina Faso

Objective: Conduct a study on cesarean sections in adolescent girls at the mother-child pool of the CHU-T in order to reduce maternal-fetal morbidity and mortality. Patients and Methods: This was a descriptive and cross-sectional study with a retrospective data collection method from January 1st, 2018 to December 31st, 2019. Results: The frequency of caesarean sections in our series was estimated at 59.9% in adolescent girls. 68.7% of adolescent girls were married, the average age was estimated at 18.3 ± 1 years, primiparous women were the most represented group with a rate of 88%. Adolescent girls were housewives in 73.5% of cases, with 37.4% of them living in rural areas. The main indications for cesarean section were: pre-rupture syndrome (22.9%), fetal distress (19.3%), pre-eclampsia/eclampsia (18.1%) and bony dystocia (21.6%). The following results derive from the classification of the cesarean section indications into 2 groups according to one or the other member of the “mother-child” couple: maternal indications accounted for 57.8% while fetal adnexal indications were estimated at 36.1%. As for perinatal mortality, it reached 24.1%. Conclusion: Improving the maternal-fetal prognosis of cesarean section in adolescent girls necessarily requires the strengthening of pregnancies follow-ups among this population group where pregnancy is most often unplanned.

Causes of Maternal Mortality According to Reports of Maternal Death Audits in the University Teaching Hospital Bogodogo (UTH-B) from January to December 2017

Objective: To study causes of maternal mortality according to reports of maternal death audits in the University Teaching Hospital Bogodogo (UTH-B) of Ouagadougou, Burkina Faso. Materials and Method: This was a prospective study that took place over a year from 1 January to 31 December 2017.? It concerned maternal deaths that occurred during this period in the obstetrics and gynecology department of the University Teaching Hospital Bogodogo (UTH-B). All maternal deaths were systematically audited by the audit committee;interviews with providers and families were sometimes conducted. The record books of all patients were analyzed by the audit committee;if necessary, interviews were conducted with care providers and families. The main information collected were recorded on individual files, entered and analyzed using the software Epi-info 7. Result: During the study period, we recorded 32 maternal deaths i.e., 587 per 100,000 live births. Deceased women under age 20 were the most numerous, followed by women aged 20 to 24. The death occurred in most cases in the puerperium in 69.80% of cases. Complications of pregnancy were the most incriminated causes in maternal deaths. Bleeding was the leading cause, accounting for 34.3%. They are followed by hypertensive disorders of pregnancy (21.8%) and infections (18.8%). In the contributing factors, resource factors were incriminated in 56.2% of cases, social factors in 43.7% of cases and medical factors in 25.4% of cases. Death was non-preventable in 76.2% of cases compared to 23.8% of preventable deaths. Conclusion: Maternal mortality is a major public health problem at the maternity hospital of the university hospital Yalgado Ouedraogo. Hemorrhage is the first cause of death. Hypertensive diseases are more and more worrying. Solutions must be found to improve the practice of audits in the obstetrics and gynecology department of UTH-B.

Prognosis of Misgav-Ladach Caesarean Sections in an African Environment: Case of the Banfora Regional Hospital in Burkina Faso about 110 Cases

Objective: To analyze the caesarean section prognosis aspects according to Misgav-Ladach versus classical technique in the regional hospital of Banfora. Materials and Methods: This is about a randomized clinical test of 2 groups carried in the regional hospital in Banfora on a two-month period from 1st October to 30 November 2015. In the first group, 66 patients had benefited from a caesarean section by the Misgav-Ladach technique. In the control group, 44 patients had benefited from a caesarean in the conventional technique. Were included in our sample all patients having benefited from a cesarean in the study site during the study period and who had consented to participate in the study. All patients were followed until the postpartum healing of the surgical wound. All prognostic elements have been compared. The results were analyzed with Epi Info 3.5.1 software and the significance level was set at 5%. Results: The indications for cesarean section were dominated by maternal causes in 70 cases (63.6%). The average duration of the surgical procedure was 27.98 mm for Misgav-Ladach technique versus 28.27 mm for the conventional technique (p = 0.49). The evaluation of blood loss by the change in hemoglobin pre- and post-operative did not find statistically significant differences between the two techniques (p = 0.6). The evaluation of the number of intraoperative suture used, was in favor of the technique of Misgav-Ladach (p = 0.007). The evolutionary trend in the intensity of postoperative pain was in favor of the technique of Misgav-Ladach. The average time of wound healing was 16.33 days for group 1 versus 21, 27 days for group 2 (p = 0.0001). Postoperative morbidity was greater with the conventional technique in comparison to Misgav-Ladach’s (p = 0.046). There was no statistically significant differences in length of hospital stay (p = 0.056). Conclusion: The Misgav-Ladach cesarean section reduces operative risk. The adoption and diffusion of this technique to the national level and its effective integration into training curriculas should contribute to reducing maternal morbidity and mortality of abdominal delivery.