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Délai entre la Prise de Décision et la Réalisation de la Césarienne d’Urgence: Effet sur le Devenir Maternel et Périnatal à l’Hôpital Central de Yaoundé
| Content Provider | Semantic Scholar |
|---|---|
| Author | Ymele, Florent Fouelifack Ngoundje, Francine Chancelle Nokam Fouedjio, Jeanne Hortence Fouelifa, Loic Dongmo Mbu, Robinson Enow |
| Copyright Year | 2019 |
| Abstract | RESUME Introduction. Le delai entre la prise de decision et la realisation de cesarienne en urgence peut influencer sur les pronostics maternel et/ou perinatal. Notre objectif etait d’evaluer le delai entre la prise de decision et la realisation d’une cesarienne en urgence, et l’effet de ce delai sur les pronostics maternel et perinatal. Methodologie. L’etude etait prospective et descriptive, sur une duree de 6 mois, soit du 1er Janvier au 30 juin 2016 dans l’Unite de Gynecologie et Obstetriques de l’Hopital Central de Yaounde. Etait inclue toute femme consentante chez qui une indication de cesarienne en urgence etait posee. Les variables etudiees etaient le temps mis entre la prise de decision et l’extraction fœtale, et les complications liees a ce temps. Les outils statistiques utilises pour nos analyses etaient la moyenne, la frequence, le rapport de cotes avec son intervalle de confiance a 95%. P etait considere significatif pour toute valeur inferieure a 5%. Resultats. Sur 1476 accouchements realises pendant la periode de l’etude, 410 (soit 27,77%) l’etaient par cesarienne. Sur les 410 cesariennes, 345 (soit 84,15%) etaient faites en urgence, parmi lesquelles 234 respectant nos criteres d’inclusion ont ete analysees. L’âge moyen des parturientes etait de 27,53 ±5,78 ans avec des extremes de 15 et 41 ans. Le delai moyen de realisation de cesariennes en urgence etait de 224,36 ± 173,30 minutes (≈3 heures et 45 minutes) avec des extremes de 15 et 864 minutes. Les complications maternelles ne variaient pas en fonction du delai de la cesarienne. Les complications perinatales augmentaient significativement lorsque le delai de prise en charge etait superieur a 120 minutes. Conclusion. Le pronostic maternel ne variait pas, mais le pronostic perinatal s’aggravait avec l’allongement du delai de cesarienne. Nous suggerons aux decideurs de pourvoir des kits d’urgence gratuits et complets, ameliorer le plateau technique, et instituer un systeme d’assurance ou de mutualisation afin de raccourcir le 3eme retard et ameliorer ainsi le pronostic perinatal dans notre pays. ABSTRACT Aim. The delay between decision-making and emergency caesarean section can influences maternal and / or perinatal outcomes. Our objective was to evaluate the delay between the decision-making and the baby extraction, and the effect of this delay on early maternal and perinatal outcomes. Methods. We carried out a prospective descriptive study, during 6 months, from January 1 to June 30, 2016 in the Gynecology and Obstetrics Unit of the Yaounde Central Hospital. We included all women with indication of urgent caesarean section who gave their informed consent. They were followed up post-operatively. Results. Out of 1,476 deliveries, 410 (27.77%) were done by caesarean section. Out of 410 caesareans, 345 (84.15%) were emergency caesarean sections. Out of 345 women with emergency caesarean sections, 234 met our selection criteria and were analyzed. The mean age of the parturients was 27.53 ± 5.78 with extremes of 15 and 41 years. The mean time to perform emergency caesareans was 224.36 ± 173.30 minutes (≈3 hours and 45 minutes) with extremes of 15 and 864 minutes. Maternal complications accounted for 74.2% preoperatively, 27.4% intraoperatively, and 24.2% postoperatively; with a maternal death rate of 0.4%. These complications were not influenced by the time of caesarean section. Major immediate neonatal complications were respiratory distress (37.2%) and neonatal infections (25.6%). They increased significantly when the management time was greater than 120 minutes, hence their immediate neonatal transfer to 47.0%. The perinatal mortality rate was 8.6%. Conclusion. The fetal outcome was worsened with the lengthening of the caesarean section. We suggest that decision-makers provide a free and complete emergency caesarean section kit, rehabilitate the operating room infrastructure, and institute an insurance or pooling system to shorten the third delay and thus improve the perinatal prognosis in our country. The creation of a neonatology service within the Yaounde Central Hospital itself would facilitate early care for newborns. |
| File Format | PDF HTM / HTML |
| Volume Number | 20 |
| Alternate Webpage(s) | https://www.hsd-fmsb.org/index.php/hsd/article/download/1381/pdf_702 |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
