Hemorrhages in the First Trimester of Pregnancy: Etiological Aspect and Management at the Maternity Ward of the Ignace Deen National Hospital of the University Hospital of Conakry

Aims: Hemorrhages in the first trimester of pregnancy constitute a public health problem in developing countries with maternal mortality which is still very high. This is the most common reason for consultation in early pregnancy. The objectives of this study were to describe the sociodemographic characteristics of the patients, identify the etiologies, describe the management and evaluate the maternal prognosis in patients presenting with hemorrhage in the first trimester of pregnancy. Methods: This was a descriptive-type prospective study lasting 12 months from January 1 to December 31, 2020, carried out at the maternity ward of Ignace Deen National Hospital. Results: During the study period, we recorded 163 cases of hemorrhage in the first trimester of pregnancy out of 5478 deliveries, i.e. a frequency of 2.97%. The main incriminated etiologies were spontaneous abortion (46.62%), ectopic pregnancy (28.22%), hydatidiform mole (16.56%), threatened abortion (5.52%) and pregnancy stopped (3.06%). The socio-demographic profile of the patients was that of a woman in the age group of 26 - 30 years (33.12%), married (79.14%), with secondary level (35.58%), exercising a liberal profession (36.19%) and nulliparous (60.12%). More than half of the patients came directly from home (57.66%) with metrorrhagia (44.78%) and abdominal pain (33.12%) as reasons for consultation. The gestational age between 7-11SA was more represented (82.82%). Manual intrauterine aspiration (58.89%) and salpingectomy (28.22%) were the most practiced therapeutic procedures. We transfused 10.42% of patients and 20.85% received medical treatment. The maternal prognosis was good in 47.87%. The main complications recorded were anemia (38.65%) and the state of shock (10.42%). Conclusion: Hemorrhages in the first trimester of pregnancy represent an important cause of maternal morbidity in developing countries. The improvement of the maternal prognosis would pass by the early consultation in front of any case of pregnancy.

Obstetric Hemorrhage during the Third Trimester of Pregnancy: Experience in a University Hospital in Guinea

Aims: Obstetric hemorrhage, especially during the 3rd trimester of pregnancy, causes maternal, fetal and neonatal mortality and morbidity. We attempted to characterize its clinical features in Guinea. The objectives of this study were to describe the socio-demographic characteristics of the patients, identify the causes and contributing factors, describe the management and evaluate the maternal-fetal prognosis in such patients. Methods: We retrieved and analyzed patients with 3rd trimester hemorrhage whom we managed at Ignace Deen National Hospital, Guinea during 1-year period (1st of December 2019-30th of November 2020). Results: We experienced recorded 401 patients with 3rd trimester obstetric hemorrhage out of 5468 deliveries during the corresponding period;the rate being 7.33%. The main causes were as follows: placental hematoma (65.33%), placenta previa (27.68%) and uterine rupture (6.99%). The socio-demographic profiles were as follows: the age group of 25 - 29 years (28.42%), married (94.51%), uneducated (50.12%), and with a liberal profession. (43.64%) and pauciparous (30.42%). The conditions were considered to be preventable by managing risk factors during the prenatal consultation (PNC): 7.73% underwent no PNC. Cesarean accounted for 84.78% of patients. Prognosis was as follows: 14 maternal deaths (3.45% of a fatality), 34.66% of anemia, and 16.95% of hemorrhagic shock. Fetal/neonatal prognoses were poor. Conclusion: Obstetric hemorrhage during 3rd trimester remains the main cause of poor outcomes in Guinea. This study identified that this type of hemorrhage still represents an important cause of maternal and fetal morbidity and mortality in developing countries.

Morbidity and Mortality Related to Obstetrical Evacuations in a Country with Limited Resources: The Case of the Maternity Ward of the Prefectural Hospital of Coyah, Guinea

Obstetric complications requiring evacuation are found all over the world with a high frequency in developing countries where they are responsible for high fetal-maternal morbidity and mortality. The objectives of this study were to calculate the frequency of obstetric evacuations in the maternity ward of the Coyah prefectural hospital, describe the socio-demographic characteristics of the evacuated patients, identify the main reasons for evacuation, determine the means of transport used and specify the maternal and fetal prognosis. Patients and Method: This was a prospective descriptive and analytical study conducted over a 6-month period (April 1-September 30, 2020) at the maternity ward of the Coyah prefectural hospital. All patients evacuated for complications of gravidopuerperium were included in the study. Results: We recorded 84 cases of obstetric evacuations out of a total of 2206 consultations, i.e. a frequency of 3.8%. The average age of the patients was 25.22 years with extremes of 15 and 45. Housewives (58.82%), nulliparous women (36.93%) and women with no education (64.29%) were the most numerous ones. No patient received medical transportation. More than half of the patients were evacuated by a nurse (51.21%). Hemorrhage in the last quarter was the main reason for evacuation. The average distance traveled by patients was 18.3 km with extremes of 12 and 68 km. The average transfer time was 63 min (1 h 3 minutes) with extremes of 20 min and 300 min (5 h). Maternal mortality was 5.95%. The perinatal mortality rate was 46.42%. No counter-referral was made. Conclusion: The obstetrical prognosis of evacuated women is still poor. We recommend the establishment of an obstetrical SAMU (UAS) system in rural areas in order to contribute to the regulation of obstetrical evacuations, but especially to enable low-income patients to have access to the service.

Gynecological and Obstetrical Emergencies at the University Clinic of Gynecology-Obstetrics of the National Hospital Donka Guinea

Gynecological and obstetrical emergencies are found all over the world, especially in developing countries where women pay a heavy price for giving birth. They can occur at any time during pregnancy and outside of pregnancy often in a socio-economic context. The objectives of this study were to describe the sociodemographic characteristics and the maternal and fetal prognosis of gynecological and obstetric emergencies. Patients and Methods: This was a descriptive cross-sectional study with prospective data collection, conducted at the University Clinic of Gynecology and Obstetrics of the Donka National Hospital between June 1 and September 30, 2015. It involved all patients admitted to our department in emergency for a gynecological or obstetrical complaint. Results: We collected 361 cases of gynecological and obstetrical emergencies out of a total of 1779 consultations, i.e. a frequency of 20.29%. Obstetrical emergencies were predominant with 91.41% and gynecological emergencies represented 8.59%. The average age of patients was 29.5 with extremes of 14 and 47. Nulliparous women were the most numerous (34.35%). More than half of the patients did not attend school (52.08%) and 56.70% were evacuees. Abdominopelvic pain and hemorrhage were the main reasons for consultation (54.29% and 49.58%). Admission diagnoses were dominated by acute fetal distress and hemorrhage in the last quarter of pregnancy (52.3% and 36.01%). The caesarean section rate was high (82.12%). Maternal and perinatal lethality rates were high (5.2% and 30.3%). Conclusion: Gynecological and obstetrical emergencies are a public health issue because of the severity of the prognosis they impose on the mother and child. Maternal and perinatal mortality was very high. The prevention of these serious emergencies must be done through good quality prenatal consultations. Laparoscopy equipment and staff training are necessary for a minimal invasive surgery of gynecological emergencies.