Incidence and outcome of severe ante-partum hemorrhage at the Teaching Hospital Yalgado Ouédraogo in Burkina Faso.

BACKGROUND: Hemorrhage is the main cause of maternal death during pregnancy. This study aims to evaluate incidence and outcomes of Severe Ante Partum Hemorrhage (SAPH) during the third trimester of pregnancy prior to delivery. METHODS: Analytical cross-sectional study with prospective data collection during 12 months in Yalgado Ouedraogo Hospital, Ouagadougou, Burkina Faso. In this context SAPH is specifically referring to Ante Partum Hemorrhage (APH) and Intra Partum Hemorrhage (IPH) in the 3rd trimester. Postpartum Hemorrhage (PPH) was not included. RESULTS: During our study 7,469 women were admitted in obstetrics and 122 cases of SAPH were recorded. SAPH represented 1.6% (n = 122) of hospitalizations causes and 14.5% (n = 1083) of hemorrhages during pregnancy. Mean age was 27.8 ± 6.9 years, mean parity 2.8 ± 1.3 and mean duration of pregnancy was 37 Weeks Amenorrhea (WA). Evacuation from other facilities was the main mode of admission (91.8%, n = 112) and blood transfusion was the essence of resuscitation. Complications were observed in 80.3% (n = 98). During the study, 118 maternal deaths were reported of which 15.6% (n = 19) related to SAPH. Among SAPH cases who died (n = 19) majority (n = 16) had severe anemia (n = 16; 82.6%, p = 0.004). Ten women (8.19%) were admitted in Intensive Care Unit (ICU). Fifteen premature births (12.3%) and 22 perinatal deaths (18.1%) were recorded. Evacuation (p = 0.04), critical clinical condition during admission (p = 0.004), and Uterine Rupture (UR) (p = 0.002) were associated with poor outcome. The Retroplacental Hemorrhage (RPH) (40.9%) was the most common cause of fetal death (p = 0.005) and was associated with High Blood Pressure (HBP) and pre-eclampsia. CONCLUSION: APH is a complication associated with significant maternal and fetal morbidity and mortality.

Therapeutic route of patients at the acute phase of their stroke in Burkina Faso.

INTRODUCTION: The advent of the neurovascular units and thrombolysis has improved support for stroke in developed countries. Our objective was to study the therapeutic route of stroke patients in Burkina Faso, a country with limited resources. METHODS: It was a prospective cohort study over a period of 4months, from February 02, 2014 to June 05, 2014, in medical emergencies and Neurology department of the teaching hospital Yalgado Ouedraogo. The study focused on patients diagnosed with stroke through brain imaging when they first entered hospital or during hospitalization. Variables of the study included socio-demographic data of the patients, route of the patients, nature of the stroke, treatment and clinical course. RESULTS: The time between the onset of clinical signs and the first contact with a peripheral public health unit extended from 30min to 24h with an average of 6h and 56min. The minimum time between the first contact with a peripheral public health unit and medical emergencies of the Teaching Hospital Yalgado Ouédraogo was 15min, and the maximum, two weeks. After their arrival in medical emergencies, patients spent on average 21h and 18min to achieve the cerebral CT scan. Concerning the treatment, the thrombolysis, which was not available yet, had never been prescribed, while 19% of patients were eligible according to the 4h30mn period criteria. CONCLUSION: Our study shows that the long delay in the access of neurological expertise is, in most cases, related to the therapeutic route of patients. Thus, the setting-up of a stroke sector would improve the management and the prognosis of cases in Burkina Faso.

Complications aigues métaboliques du diabète sucré dans le Service de Réanimation Polyvalente du Centre Hospitalier Universitaire Yalgado Ouédraogo de Ouagadougou au Burkina Faso

Objectif : Etudier les complications aiguës métaboliques (CAM) du diabète sucré dans le Service de Réanimation Polyvalente (SRP) du Centre Hospitalier Universitaire Yalgado Ouédraogo (CHU-YO) au Burkina Faso.Patients et méthodes : Etude rétrospective sur une période de cinq ans (1erjanvier 2008 au 31 décembre 2012). La population d'étude était constituée des patients admis dans ledit service pour une CAM du diabète sucré. Résultats :Soixante-six patients ont été retenus pour l'étude.La fréquence d'admission pour des CAM de diabète était de 6,5% avec un âge moyen de 55 ± 17 ans et une prédominance masculine (sex-ratio=1 ,06). Les principaux motifs d'admission étaient lecoma grave (62,1%), détresse respiratoire (81,8%) et déshydratation (15,1%).La mauvaise observance thérapeutique était retrouvée dans 64,5%.L'acidocétose constituait 59,1% des CAM suivie de l'hypoglycémie (27,3%) et du syndrome d'hyperglycémie hyperosmolaire(SHH) (13,6%). L'hyperglycémie moyenne était de 26, 31 mmol/L et l'hypoglycémie moyenne de 1,3 ± 0,7 mmol/L. Une cétonurie (69,1%) et une glycosurie (67,8%) étaient observées. Les complications étaient associées à un âge avancé (p= 0.003).L'infection constituait le principal facteur de décompensation. La durée moyenne de séjour était 5,8 ± 5,6 jours.La mortalité globale (54,55%) était liée à la gravité du coma (p=0,007).Conclusion : Les CAM du diabète sucré sont relativement fréquentes dans le SRP du CHU-YO à Ouagadougou. Le taux de mortalité est élevé. Une prise en charge précoce et adaptée pourrait améliorer le pronostic vital