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.

Men’s Knowledge, Attitudes and Perceptions on Family Planning in Tourourou Village, Gogui Rural Commune, Nioro Circle, Kayes Region of Mali

Introduction: The involvement of men in reproductive health programmes and more specifically in family planning has always been of concern to the various development actors at both national and international levels. Objective: To study the births, ideas and opinions of men on Family Planning in the village of Tourourou. Material and Methods: This was a prospective cross-sectional, descriptive and analytic study from February 1 to July 31, 2020 in the village of TOUROUROU on the Knowledge, Attitudes and Perceptions of Men on Family Planning. We included in our study, all men residing in TOUROUROU whose age is between 14 and 99 years, who agreed to participate in the study. Results: Our study involved 200 men. The 25 - 29 age group was the most represented with 25.5%. The Soninke had represented 41%. In our study, 97.5% of men had heard of family planning, 62% had spontaneously cited at least one modern contraceptive method, and the pill ranked first with 64.5%. Radio and friends were the most frequent sources of information with 57.5% and 54.5% respectively. Birth spacing was the most cited family planning goal by men in 43.5% of cases. Men supported the practice of family planning in 50.5% of cases. Conclusion: In the village of Tourourou men play a crucial role in decision-making concerning the health of the couple and the family, their effective involvement in Reproductive Health especially in Family Planning will contribute enormously to the improvement of the health of the family.

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.

The Free Cesarian in the Health District of Bougouni

Purpose: The purpose of this study was to assess the impact of free caesarean section on maternal-fetal prognosis. Materials and Methods: This was a descriptive, cross-sectional, comparative analytical study of one year of non-free caesarean section and three years of free with retrospective data collection. Our study took place from January 1, 2004 to December 31, 2004 and from January 1, 2007 to December 31, 2009. Results: Caesarean section completion rates are 1.28%, 1.30%, 1.53%, 1.32% respectively in 2004, 2007, 2008, 2009. The average age was 27 years with extremes of 15 to 40 years. The peak of evacuations was recorded in 2007 with a rate of 89.4% and the peak of direct admissions in 2009 with a rate of 14.9%. An adequate means of transport was used in 77.20%. In 22.80% of cases an inadequate means was used. The indications of caesarean sections were dominated by preeclampsia 211/1045 caesarean section followed by acute fetal suffering 179/1045;86/1045;placenta previa 64/1045;presentations of the shoulder i.e. 53/1045;pre-rupture syndrome 44/1045;retro-placental hematoma 27/1045. In terms of maternal prognosis: we noted maternal deaths with a rate of 2.4%, 2.4%, 4.3%, 0.4% respectively in 2004, 2007, 2008, 2009. And stillbirth rates were 17.6%, 22.4%, 27.4%, 21.7% respectively in 2004, 2007, 2008, 2009. The average length of hospitalization was 10 days. Conclusion: Free caesarean section would be a factor in improving the maternal-fetal prognosis.

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.

Maternal and Fetal Prognosis of Uterine Rupture in the Health District of Koutiala

Introduction: Uterine rupture is a complete or incomplete non-surgical continuity solution of the wall of the gravid uterus. Indeed, it is a Affection obstetrical condition whose maternal-fetal prognosis is poor in terms of morbidity and mortality. Objectives: To assess the risk factors for uterine rupture in the Koutiala Health District. Methods: This was a descriptive and analytical cross-sectional prospective collection study from January 1, 2019 to December 31, 2019, a 12-month period. In our study, all patients admitted to the maternity ward were included during the study period for which the diagnosis of uterine rupture was made. Results: Out of a total of deliveries, we recorded 27 cases of uterine rupture, a frequency of 1.04%. The average age of our patients was 32 years with extremes of 19 and 45 years. We notice 92.6% of uterine ruptures during the transfer. Almost 3/4 of our parturients were out of school 70.4% versus 11.1% in primary school and 18.5% in secondary school. The majority of patients affected by uterine rupture came from rural areas 85.2%. Only 14.8% were from Koutiala city. The admission time to the Koutiala Reference Health Centre was 2 hours 30 minutes in 50.85% of our patients with extremes of 15 minutes and 4 hours 30 min. The average parity was 6.30 - 3036;large multiparous accounted for 63% in our sample followed by multiparous 18.5%. As for pregnancy follow-up, 100% of the patients had not performed any prenatal consultations. In 85.2% hysterrhaphy was performed intervention and hysterectomy in 14.8%. Maternal prognosis was satisfactory in 96.30% of cases. From the point of view of morbidity: 1 case of bladder-vaginal fistula was recorded and corrected by the bladder survey at home for 15 days. Late complications were the occurrence of anemia in 16 patients who were transfused and 1 case of phlebitis. We recorded 1 maternal death and 25 stillbirths. Conclusion: Uterine rupture is one of the leading causes of maternal and fetal mortality in Mali.