Prognostic Factors for Eclamptics in Intensive Cares of Two University Teaching Hospitals in Cotonou, Benin

Introduction: In Benin, the maternal mortality rate remains high and one of the main causes is preeclampsia in its complicated forms, including eclampsia. For this, treatment is most often provided in an intensive care unit by a multidisciplinary team involving obstetricians and intensive care doctors. Objective: To determine the prognostic factors of eclamptics treated in intensive care units in two university teaching hospitals in Cotonou. Patients and Method: The study was transversal descriptive and analytical with prospective collection of data from May 1 to July 31, 2022, in the intensive care units of CHU-MEL and CNHU-HKM in Cotonou. The sampling was non-probability with exhaustive recruitment of all cases of eclampsia managed in hospital intensive care units. Clinical, therapeutic and evolutionary data were studied. Data analysis was done with Epi info 7.2.1.0 software. Results: Fifty-five eclamptics were included. The incidence was 12.39%. The average age of eclamptics was 24.67 ± 1.41 years, with a reference rate of 85.45%. Primigravidae represented 52.73%. A history of eclampsia and/or high blood pressure (14.54%) was associated with mortality. Cesarean section was indicated in 85.45% and general anesthesia, was the technique used in 95.75% of cases. Eclamptic status was found in 36.37% of patients. Other poor prognostic factors were Glasgow score of less than nine (9.09%), shock (7.27%), mechanical ventilation (58.18%) and complications. Mortality was 16.36%. Conclusion: The mortality of eclamptics in the intensive care units of CHU-MEL and CNHU-HKM was high. Poor prognostic factors were a history of preeclampsia or pregnancy-induced hypertension, severity of eclampsia and complications.

Management of Post-Operative Pain after Gyneco-Obstetrical Surgery: Practice of Transversus Abdominis Plane Bloc (Tap Block) Echoguide at the Ignace Deen National Hospital

Objectives: To describe the practice of ultrasound-guided TAP in the management of postoperative pain after gyneco-obstetric surgery. Methods: This was a descriptive prospective study carried out at the Gynecology-Obstetrics department of the Ignace Deen National Hospital over a period of three (03) months from February 01, 2020 to April 31, 2020. Results: In total, we collected 95 patients. These patients had a mean age of 30 ± 9.5 years. The ASA I class was the most represented with 76% of the cases and the cesarean was the most performed intervention. Regarding the assessment of the pain score by the simple verbal scale (SVE) postoperatively at rest, the mean SLE scores at H6 were 0.17 ± 0.38;at H12 of 1.15 ± 0.62;at H24 of 0.84 ± 0.51;at H36 0.45 ± 0.52 and at H48 0.09 ± 0.29. On mobilization, the mean pain scores were 0.77 ± 0.51 at H6, at H12 1.89 ± 0.61;at H24 of 1.53 ± 0.56;at H36 of 1 ± 0.29 and at H48 of 0.82 ± 0.44. The majority of our patients (66.3%) had a mobilization time of less than 24 hours. The mean length of stay was 3.1 ± 1.3 days and most patients (82%) were satisfied with the management of their pain by ultrasound-guided TAP block. Conclusion: Ultrasound-guided TAP is an effective technique for the management of postoperative pain in gyneco-obstetrics surgery. Its integration in a context of multimodal analgesia could improve the management of postoperative pain in gynecological obstetrics.