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Prise en charge des hemorragies du post partum immediat a la clinique gynecologique et obstetricale du chu de Lome (Togo)
Abstract
Background: Postpartum haemorrhage (PPH) remains a major cause of maternal death and morbidity.
Objective: To establish the incidence and evaluate the quality of care for PPH on attempting to reduce mortality and morbidity associated to PPH.
Methods: We conducted a prospective and descriptive study from March 2001 to February 2002 on 251 cases of PPH and their management.
Results: The incidence of PPH was 6.9 %. Risk factors were associated to PPH in 128 women (51.0 %) In one-third of the cases the PPH was severe, between which 11 cases of coagulations disorders were recorded. The median delay of management was 2 hours ranging from 1 to 72 hours. Classical “manual removal of placenta-uterine revision-oxytocin-intravenous infusion of Ringer lactate-clamping uterine arteries” to 196 women (78.0 %), repair of tears of the birth canal to 51 women (20.3 %), hysterectomy for uterus tear to 5 women (2.0 %), homeostasis hysterectomy to 11 women (44 %), and blood transfusion to 37 women (14.7 %) were practised. Maternal lethality rate was 17.9 % (45 women) representing 72.6 % of the 62 maternal deaths recorded during the study period.
Conclusion: Active and systematic management of the 3rd stage of labour, deep reorganization of the clinic at all levels, an emergency-response system and, an adequate in-service training can help us to
reduce the incidence and complications of PPH and, therefore, save more women from death.
Objective: To establish the incidence and evaluate the quality of care for PPH on attempting to reduce mortality and morbidity associated to PPH.
Methods: We conducted a prospective and descriptive study from March 2001 to February 2002 on 251 cases of PPH and their management.
Results: The incidence of PPH was 6.9 %. Risk factors were associated to PPH in 128 women (51.0 %) In one-third of the cases the PPH was severe, between which 11 cases of coagulations disorders were recorded. The median delay of management was 2 hours ranging from 1 to 72 hours. Classical “manual removal of placenta-uterine revision-oxytocin-intravenous infusion of Ringer lactate-clamping uterine arteries” to 196 women (78.0 %), repair of tears of the birth canal to 51 women (20.3 %), hysterectomy for uterus tear to 5 women (2.0 %), homeostasis hysterectomy to 11 women (44 %), and blood transfusion to 37 women (14.7 %) were practised. Maternal lethality rate was 17.9 % (45 women) representing 72.6 % of the 62 maternal deaths recorded during the study period.
Conclusion: Active and systematic management of the 3rd stage of labour, deep reorganization of the clinic at all levels, an emergency-response system and, an adequate in-service training can help us to
reduce the incidence and complications of PPH and, therefore, save more women from death.
