MATERNAL MORTALITY IN A MATERNITY WARD AT A REGIONAL HOSPITAL CENTER IN SOUTHERN SENEGAL
Biaye B, Diallo M, Guéye M, Gassama O, Niassy Diallo AC, Toure Y, Cisse M, Wade M, Ndour SB, Sarr PM, Diouf AA, Diouf A, Moreau JC.
Aristide Le Dantec hospital in Dakar, Senegal
Objectives: -to determine the maternal mortality ratio at the Kolda Regional Hospital; -to describe the socio-demographic characteristics of the deceased patients; -to clarify the causes of maternal mortality and to identify the associated risk factors.
Materials and method: This was a prospective, descriptive and analytical study conducted between January 1st, 2012 and December 31st, 2016 at the Kolda Regional Hospital Center. We collected data from maternity records, resuscitation records, anesthesia records and the operating protocol register.
Results: During this study period, we recorded 120 maternal deaths out of 4116 living births, a maternal mortality ratio of 2915.4 per 100,000 living births. The average age of our patients was 27 years old. The average parity was 4 deliveries and multiparas accounted for half of the patients. In our series, 84% of patients were evacuated; high blood pressure (35.8%) and obstructed labor (18.8%) were the most common reasons for evacuation. More than half of the deaths (52.5%) occurred in the postpartum and 32.5% in the 3rd quarter. More than half of the deaths occurred within the first 24 hours after of admission (52%). Just over a third of patients (39%) had delivered by caesarean section and we had 58.8% of perinatal deaths. The conclusions of the audit were a delay in consultation (57%) followed by a delay in evacuation (28%) and a delay in the management of patients (25%).
Conclusion: The multiple factors influencing the high maternal mortality rate in this region of Senegal can be attributed to the community, the medical team, and / or the health system. Strategic interventions to reduce this mortality rate should be based on community education on safe motherhood, on the improvement of the level of education, on communication systems and better transportation, on access to quality reproductive health services and availability of emergency obstetric care.
Keywords: Audit, maternal mortality, Kolda.
How to cite this article:
Biaye B, Diallo M, Guéye M, Gassama O, Niassy Diallo AC, Toure Y, Cisse M, Wade M, Ndour SB, Sarr PM, Diouf AA, Diouf A, Moreau JC.MATERNAL MORTALITY IN A MATERNITY WARD AT A REGIONAL HOSPITAL CENTER IN SOUTHERN SENEGAL. International Research Journal of Obstetrics and Gynecology, 2019, 2:10. DOI: 10.28933/irjog-2019-06-0506
1. WHO. Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030) Every woman, every child, UN, 2015.
2. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels JD, et al. Global Causes of Maternal Death: A WHO Systematic Analysis Lancet Global Health. 2014;2(6): e323-e333.
3. National Agency for Statistics and Demography of Senegal: Maternal mortality 2105.
4. WHO MSAS, UNFPA, UNICEF, CEFOREP Evaluation of Obstetric and Neonatal Emergency Care in Senegal 2012-2013, Dakar 2014; 30-50.
5. Saizonou J, Ouendo E M, Dujardin B. Deaths audit in four Benin Referral Hospitals: Quality of Emergency Care, Causes and Contributing Factors. Afr. J. Reprod. Health 2006; Vol. 10, n˚3 : 170-176.
6. Fomulu J N, Ngassa P N, Nong T, Nana P, Nkwabong E. Maternal Mortality at the Maternity Hospital of the Yaoundé University and Hospital Center, Cameroon: A 5-Year Retrospective Study (2002 to 2006) .Health Sci. Dis. 2009; Vol 10 (1): 22-27.
7. Saucedo M, Deneux-Tharaux C, Bouvier-Colle M H. Epidemiology of maternal mortality in France, 2007-2009. J. Gynecol. Obstet. Biol. Reprod. 2013; 42: 613-27.
8. Thiam O, Cissé M L, Mbaye M, Niang M M, Gueye M, Diouf A A, Dièye S, Moreau J C . The issue of parturients evacuated in Senegalese rural area: example of the Ndioum Hospital Center. Rev. CAMES Health 2013; Vol.1, No. 2: 51-56.
9. Mayi-Tsonga S, Oksana L, Diallo T, Metogho M, Ndombi I, Mendome G, Mounanga M, Meye J F. Study on maternal deaths at the Hospital Center of Libreville. Med. Afr. Black 2010; No. 5709: 425-431.
10. Ouédraogo C, Bouvier-Colle M H. Maternal Mortality in West Africa: How, How and Why? J. Gynecol. Obstet. Biol. Reprod. 2002; 31: 80-89.
11. Mayi-Tsonga S, Ndombi I, Oksana I,Methogo M, Diallo T, Mendome G, Mounanga M. Maternal mortality in Libreville (Gabon): state of play and challenges to be met in 2006. Cahiers Santé 2008; flight. 18, No. 4: 193-197.
12. Foumane P, Dohbit J S, Ngo Um Meka E, Nkada M N, Ze Minkande J, Mboudou E T. Etiologies of Maternal Mortality at the Gyneco-Obstetrics and Pediatric Hospital of Yaounde: a series of 58 deaths. Health Sci. Dis. 2015 ; Vol 16 (3): 32-36.
13. Rafanomezantsoa T A, Harioly Nirina M O J , Fenomanana S, Ramarokoto M P M, Andrianampanalinarivo H R , Raveloson N E. Maternal Mortalities seen at the University Hospital of Gynecology-Obstetrics of Befelatanana: 2011-2013. Med. Afr. Black 2014; No. 6112: 622-628.
14. Cissé ML, Raad B, Diouf A, Wade F, Moreau J C. Assessment of obstetric evacuation at the Kolda Regional Hospital. Med. Afr. Black 2010; Flight. 57, No. 1: 37-43.
15. WHO. The World Health Report 2005. Make every mother and child count, Genève, 2005,10-15.
16. Bouvier-Colle MH, Mohangoo AD, Gissler M, Novak-Antolic Z, Vutuc C , Szamotulska K et al. What about the mothers? An analysis of maternal mortality and morbidity in perinatal health surveillance systems in Europe.BJOG 2012; 119:889-90.
17. Dumont A, De Bernis L, Boulin D. Maternal morbidity and qualification of health personnel: comparison of two different populations in Senegal. J. Gynecol. Obstet. Biol. Reprod. 2002; 31: 70-79.
18. N’guessan E, Bouhoussou P E, Toure B, Djanhan L, Tegnan J A, Guie P A, Anongba S, Toure Coulibaly K. Risk Factors for Maternal Mortality in Adolescent Girls. About 60 cases collected at the Gynecology and Obstetrics Department of the University Hospital of Treichville.
19. Med. Afr. Noire 2010; No. 571: 521-526.
20. Chelli D, Dimassi K, Zouaoui B, Sfar E, Chelli H, Chennoufi M B. Evolution of maternal mortality in a Tunisian maternity level 3 between 1998 and 2007. J. Gynecol. Obstet. Biol. Reprod. 2009; 38: 655-61.
21. Thiam O, Cissé M L, Niang M M, Gaye A, Diouf A, Moreau J C. Maternal mortality at Roi Baudouin Health Center: about 308 cases. Mali Medical 2014; Volume XXIX, No. 3 pages 17-21.
22. Aboubakary A S. Maternal mortality at Kara University Hospital: incidence, causes and risk factors. J. of SAGO 2006; 7, (1) 21-25.
23. Diallo F B, Diallo M S, Bangoura S, Diallo A B, Camara Y. Cesarean section: Fetal and maternal mortality reduction factor at the Ignace Deen University Hospital in Conakry (Guinea). Med. Afr. Noire 1998; 45 (6): 359-364.
24. Pabamé Z et al. Quality of Caesarean section in N’Djamena health reference structures: analysis of the determinants of 235 cases.Thesis Med. N’Djamena 2002; n45: 108p.
25. Bouillin D, Fournier G, Gueye A, Diadhiou F, Cissé C T. Epidemiological surveillance and surgical coverage of obstetric dystocia in Senegal. Cahiers de Santé 1994; 4 (6): 399-406.
26. Philibert M. Epidemiology of maternal mortality in France from 1996 to 2002: frequency, risk factors and causes. BEH 2006; 50: 392-5.
27. Berg C, Bullough G, Fêtard J-F, Filippi V, Grahan W, Lewis G et al.
Beyond Numbers: Examine maternal deaths and complications to reduce the risks of pregnancy. WHO, Geneva 2004.
28. Cissé M L, Moreau J C, Faye E H O, Cissé L, Terolbe I, Diadhiou F. Cost of the evacuation of parturients to the University Hospital Center Aristide Le Dantec of Dakar. J. SAGO 2002; 1.1: 23-27.
29. Chalumeau M. Identification of risk factors for perinatal mortality in West Africa: prenatal consultation or childbirth surveillance: MMIA (Maternal Mortality in Africa). J. Gynecol. Obstet. Biol. Reprod. 2002, vol. 31, No.1: 63-69.
30. Randriambololona D M A. Evaluation of the risk factors and the maternal-fetal prognosis in the case of association high blood pressure and pregnancy at the Cenhosoa Maternity Hospital. Memory for obtaining the Diploma of Studies of Specialized Training (DEFS) in Gynecology-Obstetrics 2009; Madagascar, No. 166: 25-6.
31. Kiré B. Audit of maternal deaths at the reference center of Commune I of Bamako District. Thesis of Med. 2008; Bamako, no. 442: 70-80.
32. Mallé D, Ross D A , Campbell O M R. , Huttly S R A. Institutional maternal mortality in Mali. Int. J. Gynécol. Obstet.1994; 46:19-26.
33. Thonneau P F, Matsudai T, Alihonou E, De Souza J, Faya O, Moreau J C et al.Distribution of causes of maternal mortality during delivery and post-partum: results of an African multicentre hospital-based study. Eur. J. Obstét. Gynécol. Reprod. Biol. 2004; 114(2): 150-4.
34. Khan K S, Wojdyla D, Say L, Gülmezoglu AM, Van Look P F. WHO analysis of causes of maternal death: a systematic review. Lancet 2006 ; 367(9516):1066-74.
35. Tchaou B A, Hounkponou M F N, Salifou K, Zoumenou E, Chobli M. Obstetric emergencies at the University Hospital of Parakou in Benin: clinical, therapeutic and evolutionary aspects. Eur. Scientific J. 2015; vol.11, no.9: 260-72.
36. Bah A O, Diallo M H, Conde A M, Keita N. High blood pressure and pregnancy: maternal and perinatal mortality. Med. Afr. Black 2001; 48: 461-3.
37. Akpadza K, Beata S, Kotor K, Hodonou A K S.
Eclampsia at the Gynecology-Obstetrics Clinic of Tokoin-Lomé University Hospital (Togo). Med. Afr. Black 1996; 43: 166-9.
38. Toure I A, Bra H, Prual A. High blood pressure and pregnancy in Niger: Case-control study of 70 cases. Med. Afr. Black 1997; 205 -8.
39. WHO. Trend in maternal mortality from 1990-2015. WHO, Geneva, 2015; 2-12.
40. Benhamou D, Chassard F, Mercier J, Bouvier-Colle M H. The 2003-2005 report on maternal mortality in the United Kingdom: comments and comparison with the French data. Ann. Anesth. Rea. 2009; 28: 38-43.
This work and its PDF file(s) are licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.