Abstract
Background: Maternal mortality was insufficiently reduced in Cameroon in 2015 despite the adoption of Millennium development goals. To tackle the situation and meet the sustainable Millennium goals target of 140/100,000 live births by 2030, the Government adopted the strategies of building reference hospitals where high quality obstetric care, timely and optimal management of obstetric emergencies will be offered. The objective of this study was to describe the patterns of obstetric emergencies in Douala Gynaeco-obstetric and Paediatric Hospital, evaluate the outcomes of their management and the contribution to maternal mortality. Patients and Methods: 418 patients with obstetric emergencies were included in a two-phase cross-sectional study. Data were retrieved from patients’ case notes during the retrospective phase and a questionnaire filled for each case received during the prospective phase. Patterns of obstetric emergencies were determined and for each, the following were analysed: patient managed in this hospital or referred from other hospitals, management according to hospital guidelines, timing of care, result of management (recovery with no admission in ICU (intensive care unit), admission in ICU, death). Factors associated with each case of death were analysed. Results: The patterns of obstetric emergencies (OE) were dominated by HDP (hypertensive diseases in pregnancy) (20.57%), abortions (14.83%), Ectopic pregnancies (13.87%), Acute foetal distress (13.15%) and Obstructed labour (9.56%). PPH (post partum haemorrhage) represented 7.65% and Sikcle cell crisis (SCA) 0.91%. 40% of cases were referred from other hospitals. Six cases of deaths were recorded with a global case fatality of 1.43%. The causes of death were PPH, HDP, and Sickle cell anaemia 33.33% each. The case fatality of SCA was 50%, disclosing our worst performance. Conclusion: Management of OE following standardized hospital guidelines, reinforcement of referral systems, upgrading obstetrical services with ICU will result in least adverse maternal outcomes and especially reduced maternal mortality.
Highlights
Reducing maternal mortality by the year 2015 was one of the most challenging millennium goals pledged by the United Nations’ members in 2000
In a study conducted in Nigeria, Lamina Mustafa et al [11] found that obstetric emergencies constitute 18.5% of deliveries and represented 70.6% of causes of maternal death
Like the previous authors who evaluated the maternal mortality rate (MMR) in the reference hospitals of the country between 2000 and 2015, this rate was lower than the national level which was 782/100,000 and other rates reported in some reference hospitals in sub-Saharan Africa [12] [13]
Summary
Reducing maternal mortality by the year 2015 was one of the most challenging millennium goals pledged by the United Nations’ members in 2000. In Cameroon MMR has almost doubled from 430/100,000 live births in 1998 to 782 in 2011 [3] [5] [9] To respond to this situation, the Cameroon government has adopted amongst other strategies the one of constructing tertiary hospitals with high technology equipment, skilled health workers and other facilities with the missions of offering high quality obstetric care (state of the art obstetric care). Amongst the strategies proven efficient to reduce maternal and perinatal deaths are management of obstetric and neonatal emergencies, the antenatal care, skilled birth attendants, and good health care delivery system. To tackle the situation and meet the sustainable Millennium goals target of 140/100,000 live births by 2030, the Government adopted the strategies of building reference hospitals where high quality obstetric care, timely and optimal management of obstetric emergencies will be offered.
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