Publication:

Post-operative maternal morbidity and mortality after caesarean delivery and laparotomy for uterine rupture at the gynecology and obstetrics service of the Ignace Deen National Hospital in Guinea

Background The aim of the work was to study post-operative maternal morbidity and mortality after caesarean delivery and laparotomy for uterine failure, to describe the main causes and to analyze the risk factors.

Methods It was a descriptive, comparative and analytical study lasting 2 years with data collection in 2 phases, one of which was a retrospective study lasting one year from July 2018 to June 2019 and the other a prospective study also lasting one year, from July 2019 to June 2020. It concerned all pregnant women who had been caesarized or had had a laparotomy for uterine rupture with complications and those who had not developed any complications. The parameters studied were types of complications, risk factors and maternal mortality. The Chi-square test was used to compare the two populations with a significance level p=0.05.

Results During the study period, 6141 hospitalizations were recorded among which 5682 surgical procedures were performed, i.e. 92.52% of hospitalizations. Caesarean delivery accounted for 90.55% of surgical procedures and laparotomy for uterine rupture for 1.10%. The overall maternal post-operative morbidity rate was 7.60%. Post-operative anemia was by far the most common complication (75.76%) followed by infection (23.46%). The maternal death rate was 0.92% with a ratio of 409.97 maternal deaths per 100,000 live births and more than 2/3 of these deaths were due to caesarean delivery. Anemia and septic shock were the main causes of death. Factors related to this post-operative maternal morbidity were: age greater than or equal to 40 years, multi-parity, illiteracy, emergency obstetric evacuation, low socio-economic level, poor quality of prenatal follow-up and rupture of membranes before admission.

Conclusion In the emergency context concerning majority of our cesarean deliveries and the totality of uterine ruptures predispose the mother to high significant morbidity and mortality.