摘要
Objective: The role of anesthesia in maternal mortality is unknown in the Democratic Republic of Congo (DRC). This study was conducted with the objective of analyzing the determinants of morbidity and maternal mortality linked to anesthesia in course of cesarean section. Methods: This is a prospective, analytical and mono-centric study carried out on women who underwent cesarean section at the Centre Hospitalier Mère-Enfant Monkole from January 1st, 2011 to December 31st, 2018. The variables analyzed were socio-demographic, clinical, biological and anesthetic as well as the maternal issues. Data analysis was performed with SPSS 21.0 software. The determinants of mortality were sought by logistic regression with p Results: During this period, 1954 cesarean sections were performed. The mean age of the women was 31 years (range 14 to 47), 1549 women (79.3%) had completed prenatal consultation in Monkole and 405 (20.7%) elsewhere. The emergency was extreme in 192 cases (9.82%), absolute in 445 (22.77%) and relative in 1317 (67.4%). Locoregional anesthesia (LRA) was performed in 1811 cases (92.68%). The main complications were marked by arterial hypotension (22.9%) due to spinal anesthesia, and mortality was 0.56%. In multivariate analysis, only extreme emergency (aOR 7.62 95% CI: 2.80 - 71.23 p = 0.007), coma on admission (aOR 10.44 95% CI: 1.81 - 60.13 p = 0.009), general anesthesia (aOR 15.41 95% CI: 2.11 - 40.21 p = 0.007) and intraoperative transfusion due to anemia/hemorrhage (aOR 8.63 95% CI: 1.07 - 69.55 p = 0.043) persisted as determinants of maternal death. Conclusion: Maternal mortality (0.56%) in this series was relatively low for a low-income country and no death was directly related to anesthesia. General anesthesia, extreme urgency, intraoperative transfusion due to anemia/bleeding, and coma on admission were the major determinants of mortality.
Objective: The role of anesthesia in maternal mortality is unknown in the Democratic Republic of Congo (DRC). This study was conducted with the objective of analyzing the determinants of morbidity and maternal mortality linked to anesthesia in course of cesarean section. Methods: This is a prospective, analytical and mono-centric study carried out on women who underwent cesarean section at the Centre Hospitalier Mère-Enfant Monkole from January 1st, 2011 to December 31st, 2018. The variables analyzed were socio-demographic, clinical, biological and anesthetic as well as the maternal issues. Data analysis was performed with SPSS 21.0 software. The determinants of mortality were sought by logistic regression with p Results: During this period, 1954 cesarean sections were performed. The mean age of the women was 31 years (range 14 to 47), 1549 women (79.3%) had completed prenatal consultation in Monkole and 405 (20.7%) elsewhere. The emergency was extreme in 192 cases (9.82%), absolute in 445 (22.77%) and relative in 1317 (67.4%). Locoregional anesthesia (LRA) was performed in 1811 cases (92.68%). The main complications were marked by arterial hypotension (22.9%) due to spinal anesthesia, and mortality was 0.56%. In multivariate analysis, only extreme emergency (aOR 7.62 95% CI: 2.80 - 71.23 p = 0.007), coma on admission (aOR 10.44 95% CI: 1.81 - 60.13 p = 0.009), general anesthesia (aOR 15.41 95% CI: 2.11 - 40.21 p = 0.007) and intraoperative transfusion due to anemia/hemorrhage (aOR 8.63 95% CI: 1.07 - 69.55 p = 0.043) persisted as determinants of maternal death. Conclusion: Maternal mortality (0.56%) in this series was relatively low for a low-income country and no death was directly related to anesthesia. General anesthesia, extreme urgency, intraoperative transfusion due to anemia/bleeding, and coma on admission were the major determinants of mortality.
作者
Wilfrid Mbombo Dibue
Narcisse Kapinga Muanza
Alphonse Mosolo Nganzele
Freddy Mbuyi Wa Mukishi
Aliocha Nkodila Natuhorila
Céline Tendobi Mbamba
Sandra Bisalu Lokakao
Miki Makawani Nyani
Hervé Musubao Ngwangi
Franck Nzengu Lukusa
Rémy Kashala Badianyama
Réné Lumu Kambala
Adolphe Kilembe Manzanza
Berthe Barhayiga Nsimire
Léon Tshilolo Muepu
Wilfrid Mbombo Dibue;Narcisse Kapinga Muanza;Alphonse Mosolo Nganzele;Freddy Mbuyi Wa Mukishi;Aliocha Nkodila Natuhorila;Céline Tendobi Mbamba;Sandra Bisalu Lokakao;Miki Makawani Nyani;Hervé Musubao Ngwangi;Franck Nzengu Lukusa;Rémy Kashala Badianyama;Réné Lumu Kambala;Adolphe Kilembe Manzanza;Berthe Barhayiga Nsimire;Léon Tshilolo Muepu(Centre Hospitalier Mère-Enfant Monkole, Kinshasa, Democratic Republic of the Congo;Département d’Anesthésie Réanimation, Facultéde Médecine, Universitéde Kinshasa, Kinshasa, Democratic Republic of the Congo;UniversitéMarien Ngouabi, Brazzaville, Democratic Republic of the Congo;Universitéde Kinshasa, Ecole de SantéPublique, Kinshasa, Democratic Republic of the Congo;Département de Gynécologie Obstétrique, Universitéde Kinshasa, Kinshasa, Democratic Republic of the Congo;Hôpital de l’AmitiéSino-congolaise, Kinshasa, Democratic Republic of the Congo;Département de Biologie Clinique, Universitéde Kinshasa, Kinshasa, Democratic Republic of the Congo;Institut de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo;Centre d’Appui et de formation Sanitaire (CEFA), Kinshasa, Democratic Republic of the Congo)
