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Journal of Women's Health Care Tonato et al., J Women's Health Care 2017, 6:5
ISSN: 2167-0420 DOI: 10.4172/2167-0420.1000398

Research Article Open Access

Management of Obstetric Emergencies at the Maternity Center of the

University Hospital Center of Oueme-Plateau (CHUD O/P) in Benin
Bagnan-Tonato JA1, Lokossou MSHS1, Ogoudjobi OM1, Tognifode V1, Obossou AAA2*, Aboubacar M1, Adisso S1, Ali ARORS1, Lokossou A1 and Perrin RX1
1Department of Mother and Child, Faculty of Health Sciences of Cotonou, University of Abomey-Calavi, Bénin
2Department of Mother and Child, Faculty of Medicine, University of Parakou, Bénin
*Corresponding author: Obossou AAA, Department of Mother and Child, Faculty of Medicine, University of Parakou, Bénin, Tel: (229)-95853279/97067852; E-mail:
awadefr2000@yahoo.fr
Received date: October 06, 2017, Accepted date: October 12, 2017, Published date: October 16, 2017
Copyright: © 2017 Tonato JAB, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Introduction: Obstetric emergencies constitute public health problems in our countries.

Objective: To analyze how obstetric emergencies are managed from the clinical, therapeutic, and prognosis point
of view in the gynecology and obstetrics department of the Centre Hospitalier Universitaire Départemental of
Ouémé-Plateau.

Patients and methods: It was a cross-sectional, descriptive and analytical study carried out at the maternity
CHUD-OP over a period of 06 months from February 2016 to August 2016. It was conducted on an exhaustive
sample of all patients admitted to the CHUD-OP maternity and treated for complications of gravido-puerperium. Non-
obstetric emergencies were not included. Statistical analysis and testing were performed on CS PRO 6.2 and SPSS
software by comparing averages and deviations, using the Pearson chi-square for the dichotomous variables,
accepting a significant probability p ≤ 0.05. The principles of confidentiality were respected.

Results: The frequency of admission of obstetric emergencies was 34.9%. Epidemiologically, the mean age was
27.35 ± 5.71 years. 31.4% were nulliparous, and 69.3% had low-paid occupational activities. Clinically, the reference
was in 70.4% of cases the mode of admission, non-medical (95.1%) and without venous access (59.1%). The
causes were: dystocia (30.7%); hemorrhagic emergencies (25.9%); hypertensive emergencies (21.5%); fetal
hypoxia (17.8%) and infections (4.0%). Therapeutically, the average duration of a treatment was 4.1 ± 1.3 hours and
was performed in 67.5% of cases by a caesarean. At the prognostic level, the sequences of layers were complicated
in 10.1% of the cases, marked mainly by anemia (38.1%) and arterial hypertension (28.6%). Maternal and neonatal
lethality cases represented 3.8% and 11.5%, respectively.

Conclusion: The maternal and fetal mortality rate associated with obstetric emergencies is still high at CHUD-
OP. The reductionof morbidity and mortality requires the improvement of the quality of care and the reference
system.

Keywords: Obstetric emergency; Morbidity; Mortality; Pregnancy; Objective

Delivery
To analyze the clinical, therapeutic and prognostic aspects of
obstetric emergencies in the gynecology and obstetrics department of
Introduction the Centre Hospitalier Universitaire Départemental of Ouémé-Plateau
The obstetric emergency, the first circumstance of maternal (CHUD O/P).
mortality, is a real public health issue. Despite the implementation of
multiple programs to combat maternal mortality, about 830 women Patients and Methods
worldwide die from preventable causes linked to their pregnancy and
childbirth with 99% of all maternal deaths occurring in developing This was a cross-sectional, descriptive and analytical study
countries particularly in sub-Saharan Africa. The maternal mortality conducted at CHUD O/P maternity over a period of 06 months from
ratio in Sub-Saharan Africa is 510 maternal deaths per 100,000 live February 2016 to August 2016. The source population consisted of all
births, compared to 12 per 100,000 live births in developed countries pregnant or post-partum patients (0 to 42 days) admitted to the
[1]. In Benin in 2015, out of 100,000 live births, 405 women died from emergency department of the obstetric gynecology department of the
complications of childbirth [2]. Apart from the main causes of CHUD O/P during the study period. The target population was those
maternal deaths, delays in decision-making, access to health facilities patients with complications of gravido-puerperality.
and care occupy a no less important place in the worsening of the The obstetric emergency is defined as any pathological situation
maternal and perinatal prognosis. occurring during pregnancy, during delivery or within 42 days of the
sequelae and in which a diagnosis and treatment must be made very

J Women's Health Care, an open access journal Volume 6 • Issue 5 • 1000398

ISSN:2167-0420
Citation: Tonato JAB, Lokossou MSHS, Ogoudjobi OM, Tognifode V, Obossou AAA, et al. (2017) Management of Obstetric Emergencies at the
Maternity Center of the University Hospital Center of Oueme-Plateau (CHUD O/P) in Benin. J Women's Health Care 6: 398. doi:
10.4172/2167-0420.1000398

Page 2 of 6

quickly to preserve the maternal and/or fetal vital prognosis. In given birth in 31.4% of cases. The mean gesture was 3.04 ± 1.94
operational terms, it is the woman whose life is threatened with extremes of 1 and 12 and the mean parity was 1.91 ± 1.92
immediately within 24 to 48 hours by an obstetric pathology [3]. with extremes of 0 and 10.
• Inclusion criteria: All patients admitted to CHUD O/P maternity • The most represented occupational groups consisted: of
and treated forcomplications of gravoderma-puerperium. salespeople, artisans respectively 42.1%, 27.2%. The majority
(63.2%) were enrolled up to primary level in 30.7% (191/622).
• Criteria for non-inclusion: Non-obstetric emergencies were not
included. • Medical and surgical history: High blood pressure (HTA), blood
transfusion, viral hepatitis was found in 14.5%, 6.3% and 2.3% of
• Sampling: It was exhaustive and the sample size was 622 cases of
cases, respectively. A uterine scar was noted in 19.5% of cases.
obstetric emergencies. The variables studied were socio-
demographic, diagnostic, therapeutic and prognostic. Statistical
analysis and testing was performed on CS PRO 6.2 and SPSS Diagnostic aspects
software by comparing means and standard deviations, using the • Pregnancy monitoring: Pregnancy monitoring was done 9 times
Pearson chi-square for the dichotomous variables, accepting a out of 10 by a trained agent. The mean prenatal consultation was
significant probability p 0.05. For ethical considerations, 4.38 ± 2.39 with extremes of 0 and 12. Nearly 6 out of 10
confidentiality and anonymity were respected. pregnancies (62.4%) had at least 4 prenatal visits. The prenatal
assessment was partially completed; HIV testing (91.3%); obstetric
Results ultrasound (83.3%); blood grouping (28.4%).
• The reference of a peripheral structure was the admission mode in
Epidemiological aspects 70.4% of the cases (438/622). Transportation was unmonitored in
95.2% of cases (417/438), without an ad hoc injection system in
• Frequency: During the study period, 622 obstetric emergencies 42.2% of cases (185/438). The reference period was 1 to 2 hours in
were collected on 1784 admissions, a 34.9% prevalence of 38.5% of cases.
admissions. 1549 childbirth were performed.
• Obstetric emergencies involved 87.6% of pregnant women. They
• The average age of patients was 27.3 years old with extremes of 15 occurred at an average gestational age of 35.69 WA ± 7.89 with
and 48 years old. The most represented age group is that of patients extremes of 5 and 43 weeks of amenorrhea (WA). The majority
aged between 20 and 34 years old (80%). They were primigest and occurred in the third trimester of pregnancy (91.9%) (Table 1).
paucigest in 26.5% and 38.7% of cases respectively and had never

Number (N=622) Frequency in Percentage (%)

Pregnant women 545 87.6

1st trimester (<15 WA) 33 6.1

2nd trimester (15-28 WA) 11 2.0

3rd trimester 501 91.9

Term pregnant women [28-37 WA] 101 18.5

Before term pregnant women [37-41 WA] 347 63.7

Post term pregnant women (>41 WA ) 53 9.7

Women in postpartum 77 12.4

Table 1: Distribution of patients according to the period (gravido-puerpéralité) of occurrence of emergencies.

Main signs of severity were: palpebral mucosa (19.9%), severe From the highest to the lowest frequency, there were:
hypertensive (15.1%), meconium amniotic fluid (8.5%), shock (6, 4%),
Dystocia (30.7%); hemorrhagic emergencies (25.9%); hypertensive
convulsive seizures (4.5%), hyperthermia (4.2%), hemorrhage with
emergencies (21.5%); fetal hypoxia (17.8%) and infections (4.0%).
high abundance (3.2) and coma (0.2%).
Dystocia was mechanical in about ¾th of the cases (74.8%) (Table
The biological assessments noted severe anemia in 8.8%;
2).
leukocytosis in 38.1% and thrombocytopenia in 7.1% of cases.

Number (N=199) Frequency in Percentage (%)

Mechanical dystocia 95 47.74

Bone dystocia 55 27.64

J Women's Health Care, an open access journal Volume 6 • Issue 5 • 1000398

ISSN:2167-0420
Citation: Tonato JAB, Lokossou MSHS, Ogoudjobi OM, Tognifode V, Obossou AAA, et al. (2017) Management of Obstetric Emergencies at the
Maternity Center of the University Hospital Center of Oueme-Plateau (CHUD O/P) in Benin. J Women's Health Care 6: 398. doi:
10.4172/2167-0420.1000398

Page 3 of 6

Ovular dysfocia 40 20.10

Dynamic dystocia 50 25.12

Other

Fetal-pelvic disproportion 33 17.2

Pre-rupture syndrome 20 10.4

Failure to commit 1 0.5

Table 2: Distribution of patients by dystocia Distribution of patients according to dystocia.

Hemorrhage in the 2nd and 3rd trimester (43.5%) and postpartum Funicular causes have been the most frequent etiologies in cases of
haemorrhage (32.3%) accounted for a significant proportion of fetal hypoxia; 15 out of 25 had an ovular infection; 9 endometritis and
hemorrhagic emergencies. Severe preeclampsia dominated 1 sepsis (Tables 4 and 5).
hypertensive emergencies with 43.3% of patients (Table 3).

Number (N=161) Frequency in Percentage (%)

1st Trimester 39 24.2

Haemorrhagic Abortion 25 15.53

Ectopic pregnancy 13 8.1

Molecular Pregnancy 1 0.6

2nd and 3rd Trimesters 43.5

Placenta previa hemorrhagic 33 20.5

Retro-placental hematoma 28 17.4

Uterine rupture 9 5.6

Postpartum hemorrhage 32.3

Hemorrhage of the deliverance 25 15.5

Contemporary hemorrhage of the deliverance 22 13.7

Postpartum Postpartum Hemorrhage 5 3.1

Table 3: Distribution of patients according to hemorrhagic emergencies.

Number (N=134) Frequency in Percentage (%)

Pre-eclampsia

Severe 58 43.3

Moderate 12 9.0

Gestational hypertension 24 17.9

Eclampsia pre and per partum 22 16.4

Postpartum eclampsia 17 12.7

Hypertensive encephalopathy 1 0.7

Table 4: Distribution of patients according to hypertensive emergencies.

J Women's Health Care, an open access journal Volume 6 • Issue 5 • 1000398

ISSN:2167-0420
Citation: Tonato JAB, Lokossou MSHS, Ogoudjobi OM, Tognifode V, Obossou AAA, et al. (2017) Management of Obstetric Emergencies at the
Maternity Center of the University Hospital Center of Oueme-Plateau (CHUD O/P) in Benin. J Women's Health Care 6: 398. doi:
10.4172/2167-0420.1000398

Page 4 of 6

Number (N=63) Frequency in Percentage (%)

Anemia 24 38.1

High Blood Pressure 18 28.6

Hemorrhage 8 12.7

Infection of the surgical wound 6 9.5

Postpartum eclampsia 4 6.3

Fistule 1 1.6

Sequelae of ophthalmology of hypertension (Blindness) 1 1.6

Motor and neurological sequelae of hypertension 1 1.6

Table 5: Distribution of patients according to the nature of the complications.

Therapeutic aspects Discussion

Blood transfusion was required for 118 patients (18.9%) due to
severe anemia. The management of hypertensive emergencies was Epidemiological aspects
carried out by magnesium sulphate for cases of severe preeclampsia in Obstetric emergencies accounted for more than one-third of
95.9% of cases (93/97) and by Clonidine and/or Nicardipine for admissions in our service. A study carried out in 2013 by Tchaou et al.
hypertensive outbreaks according to the protocol. at Parakou University Hospital reported a similar frequency of 31.8%
The delivery was performed by Caesarean section in 83.8% of cases (1,231 obstetric cases including 507 emergencies) [4]. Lower
(420/501). The indications were: fetal hypoxia 97.1% (99/102); dystocia frequencies have been reported by other authors including Kadima et
95.4% (187/196); infectious emergencies 93.8% (15/16); hypertensive al. [5] in Mali in 2013 (6.03%), Steven et al. in 2012 in America (0.6%),
emergencies 65.5% (76/116); haemorrhagic emergencies 58.9% Oliveira et al. (2006) in Brazil (2.1%) [6,7]. These disparate frequencies
(43/73). show that obstetric emergencies remain a public health problem,
affecting mainly the developing countries and testify to the level of
Furthermore, we performed: 3 hysterectomies of haemostasis development of the health system.
(0.5%); 13 salpingectomies (2.9%) for ectopic pregnancy; 25 Manual
aspiration intrauterine (4.0%) and 101 uterine revision (16.2%). The According to the WHO, Girard et al. these are preventable causes in
rachi-anesthesia was the mode of anesthesia practiced in 61.3% of the the majority of cases [2,8].
cases. The average duration of patient care was 4.18 ± 1.33 hours with
extremes of 0.25 (15 min) and 191.30 min. Clinical aspects
The reference was the mode of admission in 70.4% of the cases. Our
Prognostic aspects rates are much higher than those of Tshabu at the CUGO and Cissé in
Senegal which were respectively 23.3% and 46.7% [9,10].
Maternal prognosis
The Ouémé-Plateau Departmental University Hospital Center is the
• Morbidity: The sequels were complicated for 63 patients, only public reference center in the Ouémé-Plateau area in southern
representing a rate of 10.1%. Complications were dominated by Benin. It covers an area of 1,676 km2 and includes a population
anemia (38.1%), hypertension (28.6%), hemorrhage (12.7%) and estimated at 1,100,404 inhabitants in 2013.
surgical wound infections (9.5%). The duration of hospitalization
was 2-7 days in 77% (479/622) of the cases. This was a non-medical reference (95.1%) and without venous
• Mortality: We recorded 24 maternal deaths, i.e. a maternal access (59.1%). The reference period was 1 to 2 hours in 38.5%. Tshabu
mortality rate of 24/62=0.8%. They were mostly referred (21/24). et al. reported to the CUGO that 80.5% of the patients referred were
The causes were from the higher to the lower frequency: not provided with medical assistance during their transport and
hemorrhages (50%), postpartum infections (20.7%) and anemia without venous access (37.9%) [9]. These poor discharge conditions
(12.5%). aggravate the maternal and fetal prognosis and reveal a poor
organization of the referral system for obstetric emergencies. These
Fetal prognosis transfers were responsible for 87.5% (21/24) of deaths in our study.

• Morbidity: 475 live births out of 537 were recorded (88.4%) with The causes of obstetric emergencies are the same from one study to
25.8% having poor adaptation to ectopic life, requiring neonatal another, but their ranking differs from one country to another. By
resuscitation and neonatal transfer. Neonatal distress (41.6%) and 2015, 85% of global obstetric emergencies according to WHO [2] are
neonatal infection (23.4%), neonatal distress (10.4%) and due to hemorrhages, postpartum infections, high blood pressure and
prematurity (16.9%) accounted for most of the reasons for transfer. abortions.
• Mortality: Fetal mortality was 11.5%.

J Women's Health Care, an open access journal Volume 6 • Issue 5 • 1000398

ISSN:2167-0420
Citation: Tonato JAB, Lokossou MSHS, Ogoudjobi OM, Tognifode V, Obossou AAA, et al. (2017) Management of Obstetric Emergencies at the
Maternity Center of the University Hospital Center of Oueme-Plateau (CHUD O/P) in Benin. J Women's Health Care 6: 398. doi:
10.4172/2167-0420.1000398

Page 5 of 6

In our study, classified by decreasing frequency are: dystocia, followed by infections (20.7%). The same finding was made by Chelli et
hemorrhagic emergencies, hypertensive emergencies, fetal hypoxia of al. in Tunisia, where hemorrhage was implicated in 35.5% of cases in
unidentified causes and infectious emergencies with 30.7%, 25.9%, maternal death followed by hypertension (19.3%) [15]. Foumane in
21.5%, 17.9% and 4.0% respectively. Yaoundé found high blood pressure as the leading cause of maternal
death (22.4%) followed by HIV/AIDS (19.2%) and septic abortions
Dystocias (17.2%) [16].
The frequency of dystocia was 30.7%. They were dynamic and The obstetric hemorrhagic emergency constitutes a specific situation
mechanical with a predominance of mechanical dystocia (74.8%). which imposes an immediate multidisciplinary management where
These were pelvic abnormalities (28.6%), fetal pelvic disproportions obstetrician, anesthetist-resuscitator and interventional radiologist are
(17.2%) and dystocia presentations (23.8%). Tchaou et al. [4] also involved.
found a predominance of dystocia (32.0%) over a period of 6 months.
We have recorded 62 perinatal deaths, 46 of which are per-partum.
These women should have been referenced before any work started Neonatal mortality is one of the major contingents of infant mortality
if the basin abnormalities were detected. in developing countries. Garba et al. in Niger finds a hospital neonatal
mortality rate of 85.7% [17].
Haemorrhagic emergencies
They are dominated by hemorrhages in the second and third Conclusion
trimesters of pregnancy (43.5%). They aggravate morbidity and Our study shows that emergency obstetric care deserves
perinatal mortality by induced prematurity and postpartum consolidation in our regions with the need to improve the referral
hemorrhage. system and the ongoing retraining of health workers on emergency
obstetric and neonatal care.
Hypertensive emergencies
Data from the literature show that the prevalence of hypertension References
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J Women's Health Care, an open access journal Volume 6 • Issue 5 • 1000398

ISSN:2167-0420
Citation: Tonato JAB, Lokossou MSHS, Ogoudjobi OM, Tognifode V, Obossou AAA, et al. (2017) Management of Obstetric Emergencies at the
Maternity Center of the University Hospital Center of Oueme-Plateau (CHUD O/P) in Benin. J Women's Health Care 6: 398. doi:
10.4172/2167-0420.1000398

Page 6 of 6

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J Women's Health Care, an open access journal Volume 6 • Issue 5 • 1000398

ISSN:2167-0420