Management of Obstetric Emergencies in a Tertiary Hospital in Cameroon: A Milestone for End of Preventable Maternal Deaths

Background: Maternal mortality was insufficiently reduced in Cameroon in 2015 despite the adoption of Millennium development goals. To tackle the situation and meet the sustainable Millennium goals target of 140/100,000 live births by 2030, the Government adopted the strategies of building reference hospitals where high quality obstetric care, timely and optimal management of obstetric emergencies will be offered. The objective of this study was to describe the patterns of obstetric emergencies in Douala Gynaeco-obstetric and Paediatric Hospital, evaluate the outcomes of their management and the contribution to maternal mortality. Patients and Methods: 418 patients with obstetric emergencies were included in a two-phase cross-sectional study. Data were retrieved from patients’ case notes during the retrospective phase and a questionnaire filled for each case received during the prospective phase. Patterns of obstetric emergencies were determined and for each, the following were analysed: patient managed in this hospital or referred from other hospitals, management according to hospital guidelines, timing of care, result of management (recovery with no admission in ICU (intensive care unit), admission in ICU, death). Factors associated with each case of death were analysed. Results: The patterns of obstetric emergencies (OE) were dominated by HDP (hypertensive diseases in pregnancy) (20.57%), abortions (14.83%), Ectopic pregnancies (13.87%), Acute foetal distress (13.15%) and Obstructed labour (9.56%). PPH (post partum haemorrhage) represented 7.65% and Sikcle cell crisis (SCA) 0.91%. 40% of cases were referred from other hospitals. Six cases of deaths were recorded with a global case fatality of 1.43%. The causes of death were PPH, HDP, and Sickle cell anaemia 33.33% each. The case fatality of SCA was 50%, disclosing our worst performance. Conclusion: Management of OE following standardized hospital guidelines, reinforcement of referral systems, upgrading obstetrical services with ICU will result in least adverse maternal outcomes and especially reduced maternal mortality.