Impact of the introduction of the active follow-up care of the third stage of childbirth in the prevention of delivery hemorrhage in the obstetrical gynecology department

Abstract

Background: The majority of pregnancies and births proceed without complications. However, all pregnancies present risks of complications that could endanger the maternal prognosis. One of the most serious of these complications is the bleeding during delivery. It’s often unpredictable nature, when it occurs, involves an urgent obstetric situation which requires early diagnosis and rapid and effective follow-up. The general objective of this study was to assess the impact of the introduction of the active follow-up care of the third phase of childbirth in the prevention of bleeding during delivery with our place of study, the obstetrical gynecology department of Kindia regional hospital (Konacri Guinea), with the aim of optimizing the follow-up care of pregnant women during their childbirth. Methodology: We carried out a case-control study with both retrospective and prospective data collection on the records of participants with cases of hemorrhage during delivery in the gynecology department of the Kindia regional hospital. Retrospective data collection covered a period of 25 months before the active follow-up care of the third stage of childbirth and concerned the control group of study participants, while the one of prospective data covered a period of 19 months after the introduction of the active follow-up care of the third stage of childbirth from the 1st January 2019 to 30th September 2020 and concerned the cases group. The criteria for matching these two groups of study participants were the diagnosis and the follow-up of the delivery hemorrhage. Results: During our study period in the gynecology department of the Kindia regional hospital, we identified 223 cases of delivery hemorrhage out of 2198 deliveries before the period of introduction of the active follow-up care of the third stage. This represents an incidence of 10.14%, compared to 73 cases of delivery hemorrhage out of 2714 deliveries during the period of the active follow-up care of the third stage. For an incidence of 2.68%. We found that the hemorrhages during delivery did not spare any age group and were observed for all parities. There were common reasons for admission before and after the integration of the active follow-up care of the third stage of childbirth namely vulvar hemorrhage and physical asthenia, which were reflected in the clinical picture of all cases bleeding from the issue. In addition, headaches, dizziness, and thirst were found, but in different proportions and significantly less frequent since the introduction of the active follow-up care of the third stage of childbirth. This sign were in this context the consequence of the state of shock with respective frequencies of 46.63% and 28.76% before and after the introduction of the active follow-up care of the third stage of childbirth and anemia was present in all cases of delivery hemorrhage. Conclusion: The introduction of active follow-up care of the third stage of childbirth has reduced the frequency of delivery hemorrhages and may therefore help to reduce maternal morbidity and mortality.