Maternal deaths by haemorrhage in the gynaecology and obstetrics department at the teaching hospital of cocody

Objective: To improve the management of hemorrhagic complications during gravido-puerperium in order to reduce its lethality in the gynaecology and obstetrics department of Cocody’s Teaching Hospital. Patients and methods: This was a retrospective and descriptive study that involved women who died of hemorrhagic causes in the service during the period of gravido-puerperium as defined by the WHO. It covered a period from 1 January 2014 to 31 December 2017 at the Gynaecology and Obstetrics Department of Cocody’s Teaching Hospital. Results: We selected 74 deaths due to hemorrhage, a mortality ratio of 275 deaths/100,000 live births. The peak of deaths of 19 (25, 6%) was observed in 25-30 years. Multiparous accounted for 57.6% of cases. Patients were evacuated to Cocody’s Teaching Hospital in 100% of cases. Patients were evacuated no later than the hour following the decision to evacuate in 17.5% of cases. Patients were admitted to a precarious state in 82.4% of cases (hypovolemia shock, severe anemia, coagulopathy). There were 64.9% of patients with immediate postpartum hemorrhage (IPPH), followed by 21.6% retroplacental hematoma (RPH) and 13.5% uterine rupture (UR). In 58.1% of cases, the transfusion could not have taken place due to a lack of blood products. All deaths were preventable. Conclusion: Haemorrhage remains the leading cause of maternal death in our service. Although obstetric emergencies from peripheral maternity wards are not subject to optimal qualified assistance at delivery, the delay in transfusion was considered as a determining factor in the occurrence of deaths. Given the medico-legal risk associated with these deaths, prevention is the best response in developing countries.