Socio-Epidemiological Aspects and Prognosis of Unassisted Deliveries Arriving at Fousseyni Daou Hospital in Kayes

Introduction: The World Health Organization estimates that each year more than 20 million women suffer from the after-effects of unattended childbirth, of which 800 women die every day as a result of obstetric complications. Objective: Study the socio-epidemiological aspects and prognosis of unassisted deliveries arriving at the Fousseyni Daou De Kayes hospital. Materials and Methods: This was a descriptive, cross-sectional study with prospective collection, case-control that took place at the maternity ward of the Fousseyni Daou hospital in Kayes, from 1 January to 31 December 2021. Results: The frequency of unattended birth was 4.1%. The 30 - 35 age group was the most represented with 32.5%. In our study 58.1% of cases were out of school, 19.4% were primigestes and 39.4% were multiparous. In our series 60.6% of cases had given birth at home and 39.4% along the way. The majority of cases regretted having given birth without the assistance of qualified personnel in 45.6%. Maternal complications were dominated by perineal lesions in 14.4% of cases, haemorrhage of delivery in 25% of cases, severe anaemia in 30% of cases;16.7% of newborns were in poor condition, 13.6% were fresh stillbirths, 15.6% of newborns had obstetric trauma. The maternal death rate on arrival was 3%. Conclusion: The frequency of unassisted childbirth is high in the Kayes region. Its complications can be serious for both the mother and the newborn.

Vaginal Caesarean Section: A Review of Indications in Mali

Introduction: The vaginal caesarean described since the 19th century remains unknown to many practitioners. The publications available on the subject are rare. The objective of this review is to report the experience of our team in Mali on vaginal cesarean section. Materials and Methods: This is a documentary review of a series of 5 cases on the practice of vaginal caesarean section at the Sominé Dolo Hospital and Reference Health Center of the Sanitary District of Bla in Mali between 2005 and 2022. Results: We performed a vaginal caesarean section on 5 patients in this series. The indications were retroplacental hematoma in 2/5 cases including 1 with a live fetus, eclampsia crisis in 1/5 cases, dystocia on uterine prolapse in 1/5 cases and beating cord prolapse in 1/5 cases. In the 5 cases, the pregnancy was not at term. In 3/5 cases, cesarean section was indicated to save the non-term fetus with a very low possibility of success by classic cesarean section and in 2/5 cases for maternal rescue with fetal death in utero. 2 live newborns were released in satisfactory condition, 1 died after 6 hours of life. Antibiotic therapy was not necessary in the majority of cases. The average length of hospitalization was 3 days. Conclusion: The circumstances of the realization of the vaginal cesarean section in our series of studies remain frequent in the practice of modern obstetrics. The short duration of hospitalization and the low use of antibiotics can contribute to the reduction of the medical cost of caesarean section in low-income countries, such as Mali.

Maternal Deaths in Patients Evacuated to the Fousseyni Daou Hospital in Kayes over a Decade

Introduction: Evacuation refers to the rapid transfer of a patient in an emergency, from one health center to another more equipped and better specialized. The objective of this study was to study maternal mortality in patients evacuated to the gynecology and obstetrics department at the Fousseyni Daou Hospital in Kayes over a period of 10 years. Materials and Methods: This was a descriptive, cross-sectional, retrospective study over nine years from January 1, 2011 to December 31, 2019 and prospective over one year from January 1, 2020 to December 31, 2020 involving all patients or parturients evacuated for obstetrical causes and died in the gynecology-obstetrics department of the Fousseyni Daou Hospital. Confidentiality and anonymity were respected. The processing and analysis of the statistical data was carried out using SPSS 20.0 software. Results: during our study period we identified 38,854 obstetric admissions including 6758 evacuations or 17.4%, among the 6758 cases of obstetric evacuations 284 died, a frequency of 4.2%. The maternal death audit committee of the Fousseyni Daou hospital in Kayes audited 101/284 cases (files) or 35.5% of which 64 maternal deaths (63.4%) were considered inevitable. In our study the 20 - 29 age group was more represented with 38%. 85% of the deceased patients lived in rural areas. In our series, 63.7% of the deceased patients had not had antenatal consultations (NPC). Eclampsia accounted for 26.8% of admissions diagnoses and 30.9% of causes of death. Seventy-two (72%) of deaths occurred postpartum, 15% perpartum and 13% prepartum. Direct obstetric causes were predominant at 65.1%. Conclusion: Indicators of maternal deaths among evacuated patients remain poor in our work. Maternal deaths were driven by socio-economic and cultural factors, but also by factors related to the health system.

HIV/AIDS Screening in the African Birthplace (Hospital in Kayes, Mali)

Purpose: The purpose of this study was to determine HIV prevalence among participants admitted to the delivery room and recent birth attendants. Materials and Methods: This was a descriptive, cross-sectional, analytical study, with a prospective collection from February 1, 2018 to January 31, 2019 at fousseyni Daou Hospital in Kayes, Mali. Results: During our study period, we recorded 4269 deliveries. HIV-positive patients known before labour accounted for 0.21%. Four hundred and six participants received counselling/testing in the delivery room;of which 36 refused the test: 8.87% and 370 accepted or 91.13%. Thirteen patients tested positive or 3.51%. The 20 - 35 age group was the most represented at 76.92%. Positive patients tested received ARV treatment in the delivery room in 92.31% of cases;and 1 patient or 7.69% did not receive treatment for refusal. Vaginal delivery was the most common at 77%, with caesarean section 23%. Newborns had a good prognosis in their first weeks of life in 85%;fetal lethality was observed in 15% of newborns including 1 case of fresh stillbirth and 1 case of pediatric deaths for neonatal suffering. Conclusion: Counselling and voluntary HIV/AIDS testing during labour and immediate postpartum can detect many pregnant women who escape screening during antenatal consultations.

Maternal-Fetal Prognosis of Delivery in the Presentation of the Seat at the Kayes Hospital (Mali)

Objective: The purpose of this study was to assess the risk factors associated with seat presentation and to determine the maternal-fetal prognosis of delivery in the presentation of the seat. Materials and methods: This was a descriptive, cross-sectional and analytical case-control study with prospective data collection, from January 1, 2018 to December 31, 2019, a 12-month period at Kayes Hospital, Mali. Results: During our study period we recorded 3820 deliveries, including 120 breos;a frequency of 3.14% of all deliveries. The 20 - 35 age group was the most represented in cases 61.7%. Of the cases 66.7% (n-80) were out of school, we note 75.8% (n-182) of out-of-school controls. Primiparaes were the majority among cases 39.2% (n-47), as were 39.1% of the controls (n-118). The cases had a history of caesarean section at 15% (n-18);13, 3% (n-32). The most common mode of presentation was the 70% decomplete seat. It was mainly the anterior left sacro iliac variety (85.8%). The low pathway was preferred during these deliveries to 70% against 30% of caesarean section of which 28.3% of cases were carried out in an emergency. Several factors such as delivery pathway, mode of presentation, length of expulsion and obstetric manoeuvres used influenced fetal prognosis. Fetal complications were dominated by acute fetal suffering (15.8%), followed by dislocation of the shoulder (0.8%). The most common morbid maternal complications were soft part tears (15 cases or 12.5%) and parietal suppuration (1 case or 0.8%). We did not record any maternal deaths. Conclusion: Our results confirm that childbirth is a risky delivery, and must require careful selection of eligible cases and rigorous management of labour with trained teams. In these circumstances, it seems totally abusive to advocate as a single mode of delivery caesarean section in all presentations of the chair in the primigestes.