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

摘要

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.