Maternal and child health is part of the health development plan of many countries.
For each review of maternal death, 30 to 100 women are victims of maternal morbidities
[1]. At least 20% of the dominant diseases in children under 5 years of age are linked to
poor health, poor nutrition of the mother, as well as insufficient quality of care during
pregnancy, childbirth and the first days of life [2]. To reduce the risk of death from birth
and complications of pregnancy, the WHO in 2016 defined a new model with eight prenatal
contacts, replacing the refocused antenatal consultation model, thus constituting a platform
to provide important health benefits including health promotion, screening, diagnosis and
prevention of disease [3]. Complications most often appear during pregnancy and could be
avoided or treated; others that existed prior to pregnancy worsen at this time, especially if
they are not taken into account within the framework of the care [4].
Methods
This was a descriptive and analytical cross-sectional study with retrospective data
collection at the Endoscopic Surgery and Human Reproduction Teaching Hospital (CHRACERH) over a period of 3 years, from May 2016 to May 2019.
We included all pregnant women followed at CHRACERH, whose
pregnancy was associated with a maternal pathology diagnosed
before or during pregnancy and having completed it at CHRACERH.
We excluded patients with trauma, injuries and those with a disability
that occurred before pregnancy. The sampling was consecutive
and exhaustive. The variables collected were socio-demographic
characteristics, obstetric history, past medical and surgical history
of patients. We also evaluated various aspects of the antenatal care,
such as, the quality of prenatal visits (gestational age at first ANC,
number of ANC visits), preventive aspects (anti-anemic, anti-malaria
prophylaxis) and curative aspects (pathologies diagnosed and
managed during pregnancy) and the materno-fetal outcome of the
pregnancy. The data collected on the technical sheet were entered and
analyzed respectively, with CS Pro version 7.1 and SPSS version 25.0
software. The tables were drawn up using Microsoft Office Excel and
Word 2013 software. Averages were calculated for the quantitative
variables and frequencies for the qualitative variables. The cross
tab was used to compare the qualitative and quantitative variables.
The odds ratio with its 95% confidence interval was used to assess
the degree of association between the variables. The significance
threshold was set at 5% or 0.05.
Results
At the end of our study, 249 patients fulfilled our inclusion
criteria among the 1132 pregnancies received during our study
period, giving a prevalence of 22% (95% CI: 19.7 - 24.5). The mean
age of the patients in our study population was 31.19 ± 8.19 years
with extremes from 12 to 51 years. The most represented age group
was that of 31 to 36 years (32.6%). The majority of patients (53.8%)
were married. The majority of the patients were employed (67.1%);
had a higher level of education (75.9%) and lived in Yaoundé (88.8%)
(Table I).
Multigravid women represented 53.8% of our study population.
The majority of pregnant women in our study were nulliparous
(41.4%) and 32% had a history of infertility (Table II)
The pregnancy occurred spontaneously in 226 patients or
90.8% and only 23 patients (9.2%) had benefited from medically
assisted procreation. The majority of pregnant women (90.8%) had a
singleton pregnancy; 8 (3.2%) had a twin pregnancies and 4 (1.6%)
had triplets (Table III).
The maternal pathologies found during pregnancy and classified
in decreasing order of frequency were malaria in 99 cases (39.8%),
genital infections in 67 cases (26.9%) and anemia in 66 cases (26.5%)
(Table IV).
The most frequent complications found were; eclampsia in
7 cases (2.8%), premature rupture of the membranes in 6 cases
(2.4%), Abruptio placenta in 4 cases (2.4%), threatened abortion and
premature delivery in 2 cases (0.8%) (Table V).
Eclampsia was the main complication in women with
hypertensive disorders (Table VI)
The pregnancy ended in an abortion in 3.6% of the cases; a
premature delivery in 5.2% of the cases, a post-term delivery in 0.8%
of the cases and 90.4% of the patients carried their pregnancy to
term. Vaginal delivery was the most frequent at 63.4% (with 3 cases
of instrumental delivery recorded) and the cesarean section rate was
at 36.6% (with 18.8% elective and 17.8% urgent indications) (Table
VII).
The majorities of the newborns were born alive (98.8%), of
normal morphology (99.6%) and had a good adaptation to extra
uterine life (94.4%) (Table VIII).
