Perioperative Materno-Fetal Morbimortality Related to the Caesarean in the Hospital Setting in Mali

Abstract

Introduction: During childbirth by Caesarean, several types of anesthesia can be used. The Caesarean, the most practiced surgical delivery technique in obstetrics, has a risk for complications for both the pregnant women and newborns. Objective: To evaluate the importance of the complications due to Caesarean in the Teaching hospital Gabriel Toure. Patient and Methods: We conducted a cross sectional survey in the departments of intensive care unit and gyneco-obstetric from January to August 2017 in the University hospital Gabriel Toure of Bamako. Our study population was pregnant women who gave birth to children by Caesarean. We included all cases of preventive and emergent Caesarean under loco-regional or general anesthesia. Data were compiled from the obstetrical files of the patients, the anesthetic consultation registry and the databasis of the department of gyneco-obstetric. The test of khi2 of Pearson was used for the comparison of our results with a value of p < 0.05 considered as statistically significant. The consent of the patients or parents was gotten. The survey didn’t include a potentially dangerous act. Results: During the study period, 1875 childbirths have been recorded of which 633 were by Caesarean (33.7%). We collected and analyzed 524 files of Caesarean. The mortality rate was 1.5% in pregnant women and 15% in newborns. The average age was 26.6 ± 6.9 ans. Pregnant women were referrals in 59.4% of the cases. The most frequent motive of referrals was high blood pressure and pregnancy in 66.6%. The Caesarean was indicated in most of the cases on previously operated uterus in 22% and eclampsia was present in 14%. The maternal mortality had occurred in a context of hemorrhage in 50% of the cases. The factors of maternal morbi-mortality were the mode of admission, iterative Caesarean, t surgeon, context of the Caesarean, realization of the anesthetic consultation and the technic of anesthesia (p = 0.05). The factors of fetal mortality were the realization of endo-tracheal intubation, technic of anesthesia, realization of the anesthesia consultation, context of the Caesarean, iterative Caesarean and the mode of admission (p ≤ 0.05). Conclusion: The caesarean is associated with a high risk of maternal complications and a very important fetal mortality. The anesthesia consultation in the follow-up of pregnancy would reduce this high mortality.