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Background: Quality assurance in labor and delivery is needed. The method must be simple and consistent, and be of universal value. The 10-Group Classification System is a simple method providing a common starting point for further detailed analysis within which all perinatal events and outcomes can be measured and compared. Objective: The purpose of this study was to analyze cesarean section (CS) rates using the classification system of Robson’s ten groups and to identify the main contributors to the overall CS rate in Burkina Faso’s regional and university hospitals. Materials and Method: A cross-sectional study with retrospective collection was carried out. All women who gave birth between July 1, 2017 and June 30, 2018, in the Regional Hospital Centres (RHC) and University Hospital Centres (UHC) of Burkina Faso were classified according to the Robson ten-group method. The overall CS rates and in each Robson group were calculated, as well as the contribution of each group to the overall CS rate. Results: The CS rate was 26.5% (8543 out of 32,240 deliveries) during the study period. nulliparous women with single term pregnancy in cephalic presentation during spontaneous labour (group 1), multiparous women with single pregnancy in cephalic presentation, gestational age ≥37SA, spontaneous labour (group 3) and multiparous women with previous CS (group 5) were the main contributors (67.7%) to the overall CS rate. In addition, we observed a variation in CS rates between different hospitals, especially among women with full-term pregnancies in cephalic presentation without previous CS (groups 1 to 4), showing large differences in emergency obstetric and neonatal care across the country. Conclusions: Women in groups 1, 3 and 5 were the most important contributors to the overall CS rate in Burkina Faso. It appears that efforts to reduce the overall rate of CS should focus on vaginal delivery on the scarred uterus, reduction of CS rates in nulliparous women with full-term pregnancy in cephalic presentation (groups 1) and proper monitoring of multiparous women with full-term pregnancy in spontaneous labour (group 3).

Objective To study the contribution of blood transfusion management in the improvement of maternal and perinatal outcomes in pregnant women with sickle cell disease in Ouagadougou. Methods A cross-sectional retrospective study with data collected from February 2012 to January 2014 was used. Patients were differentiated into three groups: patients with at least one exchange transfusion, patients who received blood transfusion, and patients who did not receive any transfusion. Data were collected from patients' patient care documents. Results One hundred and sixty-four patients were included, of whom 53 were in the first group, 32 in the second group, and 79 in the third group. Maternal complications in the last trimester of pregnancy were significantly less important (P=0.000) in the first group (58.5%) than in the second (78.5%) and third group (91.1%). The same trend was observed for postpartum maternal mortality (5.7%; 12.5%; 12.6%; P=0.009). Fetal complications such as preterm birth and early neonatal death were lower in the first group (15.1%; 1.8%) than in the second (40.6%; 23.1%) and third group (32.9%; 7.6%). Conclusion Prophylactic blood transfusion is an important part of the management of pregnant patients with sickle cell disease.

Background: Anaemia in pregnancy is a public health issue in developing countries because of its high prevalence and its maternal and perinatal bad outcomes. It affects 24.8% of the world population and 67.6% of the population in sub-Saharan Africa. In Burkina Faso, anaemia prevalence is estimated at 68.3%. In Burkina, preventive measures for anaemia in pregnancy have been implemented by the ministry of health to reduce its burden. This study aimed to assess the epidemiological, clinical and the outcomes of anaemia in pregnant women at OUAHIGOUYA REGIONAL HOSPITAL. Findings will be used to strengthen the preventives measures for anaemia in pregnancy. Methods: A cross-sectional descriptive and analytical study was conducted during a four-month period from October, 28th, 2014 to February, 28th, 2015. pregnant women with haemoglobin level below 11 g/dL was considered anaemic according to WHO criteria, and who are willing to participate and who were admitted at the obstetrics and Gynecology department of the REGIONAL HOSPITAL of OUAHIGOUYA. Results: Four hundred eighty three pregnant women were anaemic out of eight hundred eighty three women hospitalized. The prevalence of maternal anaemia was 54.7% with significant monthly variations. The mean age was 24.7 ± 6.6 years. The women without non-salary occupation (housewives and pupils) represented 90.1%. A past medical history of haemoglobin defects (6.6%), twin pregnancies (6.0%), malaria (23.6%) bleeding during pregnancy (20.3%) were the most frequent. Monitoring the pregnancy was effective in 91.1% of women. The mean haemoglobin level was 8.8 ± 2.1 g/dL. The outcome was marked with 1.7% and 18.9% maternal and perinatal death respectively. The most common contributory factors were: Occupational status, number of prenatal visits, length of treatment with iron and folic acid, history of malaria, history of haemorrhage and brachial perimeter low (p < 0.05). Conclusion: Maternal anaemia is a major health issue at the OUAHIGOUYA REGIONAL HOSPITAL in Northern Burkina Faso. Maternal and perinatal outcomes could be improved by reinforcing the preventive measures but also by improving the nutritional status and the living conditions of pregnant women.

Objective: To describe the epidemiological, clinical and therapeutic aspects of cases of vaginal bleeding in the nonpregnant patient received in emergency at Yalgado OUEDRAOGO University Hospital. Materials and Methods: It was a retrospective and descriptive study that involved the clinical records of 326 patients collected from January 01, 2009 to December 31, 2013. Results: The average age of women was 47 years old with extremes at 12 and 82 years old. Women of childbearing age accounted for 61.6% and postmenopausal women 18.7%. 70.7% of women were pauciparous or nulliparous. Menorrhagia and pelvic pain were the main signs associated. This symptomatology required hospitalization in 85.2% of cases. The main aetiologies were uterine myomas 49.69%, cervical cancer 23% and functional metrorrhagia 11.04%. Progestin was the most used drug in 67.1% of cases. Total abdominal hysterectomy and abdominal myomectomy were the most commonly used surgical methods with 22.3%, 44.4% of cases. Eleven death cases were observed. Conclusion: Gynecological metrorrhagia is more common in women of childbearing age than in menopausal women. The main causes are fibroma, cervical cancer and functional metrorrhagia.

Objective: To determine the frequency of obstetrical vacuum deliveries in the service of obstetrics and gynecology of regional teaching hospital of Ouahigouya and then to assess fetal outcomes. Patients and Methods: It was about a cross sectional and descriptive retrospective data collection from 1st January 2014 to 31st December 2016 in the service of obstetrics and gynecology of regional teaching hospital of Ouahigouya. Patients who had vacuum delivered in the service with single pregnancy, at least 34 weeks gestation age and summit presentation and had a useful medical folder were included in our study. The data were collected and the analysis used epi-info software 7.2.1.0. version, 2010 Word and excel. The results were presented in percentage for qualitative variables and in means standard deviation for quantitative variables. Results: We have collected 6233 deliveries from 1st January 2014 to 31st December 2016, out of which 312 were done by using obstetrical vacuum giving a frequency of 5.0%. The mean age of patients was 23.5 ± 6.4 years. The average parity was 1.3 ± 0.7 women per delivery and 73.1% of our patients were pauciparous. 90.1% of patients were referred. The main indications were maternal weakness (43%), fetal distress (36.5%), prolonged expulsive phase (6.1%), stopping progression (4.8%) and the scar uterus (4.5%). Fetal prognosis was dominated by the caput in 13 cases (4.2%) and excoriations of the scalp in 5 cases (1.7%). Conclusion: Vacuum extractions are very limited in low setting countries. Its popularization is essential to reduce maternal and fetal mortality.

Aim: To report a case of bilateral tubal molar and embryonic pregnancy diagnosed and treated at the Yalgado Ouedraogo Teaching Hospital in Ouagadougou, Burkina Faso. Observation: It was an 18-year-old patient, G2P0 with no known pathological history. She was received in obstetric emergencies for suspicion of ectopic pregnancy in a two-month amenorrhea context. At the admission, the physical examination had found a sensitivity of the hypogastric region with a cry of the umbilicus and the bleeding. At pelvic ultrasound, the uterus was empty with a medium-abundance pelvic effusion and a left extra uterine mass. The initial rate of beta HCG was 5700 ml IU per ml. A framed laparotomy was carried out. The operative exploration has revealed a right tubal pregnancy cracked and a left unbroken tubal pregnancy. The diagnosis of a bilateral ectopic pregnancy was retained. A right salpingectomy and a left tubal caesarean section were carried out. Histological analysis confirmed the diagnosis of a left embryonic ectopic pregnancy associated with a right molar ectopic pregnancy. Conclusion: The systematic use of histological analysis for any extra uterine pregnancy treatment is required to not ignore an associated molar pregnancy.

Objective: The objective of our study was to study the risk factors of low birth weight at term in the Teaching Hospital Yalgado (CHU-YO) Ouedraogo. Patients and Methods: This dealt with a comparative and analytical control case study. The group of cases was made up of female patients who gave birth to newborns with low birth weight at term and that of control cases included female patients who delivered a normal-weighted newborn at term. Results: The frequency of low birth weight at term was therefore estimated at 4.4%. The average age of the parturients was 25 ± 6.36 years. Female patients living in a marital setting accounted for 93.1% of cases and 64.4% of them had no income-generating activities. A maternal underweight, a height below 155 cm, passive smoking, and malaria during pregnancy have been identified as the factors associated with a low birth weight. Conclusion: Quality prenatal care could reduce the incidence of low birth weight at term.

The objective of our study was to study the epidemiological, etiological and contributory factors of maternal deaths in the obstetrics and gynecology department of the regional hospital center (RHC) of Ouahigouya from 2013 to 2015. We carried out a descriptive and analytical study on maternal deaths in maternity of the RHC of Ouahigouya, including all patients who died in the obstetrics and gynecology department of the RHC of Ouahigouya from 1 January 2013 to 31 December 2015, which meets WHO’s definition of maternal death. We recorded 151 maternal deaths and 5481 live births, a maternal mortality ratio of 2755 per 100,000 live births. The most affected women were women aged 20 - 24 years (27.8%), multiparous (25.5%), married women (88.7%) and those without income-generating activities (85.4%). The main causes of death from direct obstetrical complications were hemorrhage (38.3%), infections (21.5%), abortions (16.8%) and complications of hypertension disorders (15.8%) and for indirect obstetrical complications, malaria (36.6%), anemia (29.5%), and HIV/AIDS (9.1%). Contributing factors to maternal deaths prior to admission were delay in referral (33.3%) and delay in transfer (31.5%) and delay in admission (32.8%) and delay in diagnosis (23.4). From our study, it appears elsewhere as well as that most maternal deaths are preventable, hence the need for coordinated actions to effectively fight against maternal mortality.

Objective: To study epidemiological, clinical ant therapeutic aspects of placental abruption in the service of obstetrics and gynecology of regional hospital center of Ouahigouya. Methods: We conducted a cross-sectional study scheduled for 3 years, from 1st January 2013 to 31st December 2015. Data were collected from patients’ folder, theater register and maternity delivery register. Results: We recorded 5791 deliveries, out of which 89 were placental abruption cases giving a rate of 1.54% of deliveries. The women most affected were whose with age ranging 25 - 30 years (30.33%), the nulliparous women (32.58%), the married women (83.52%) and whose with bad antenatal clinic attendance (54.6%). The clinical aspect was most often complete: nil fetal heart rate (82.00%), hypertony uterine (79.90%) and vaginal bleeding (74.20%) were the most signs found. Spontaneous vaginal delivery has been made in 64.04%. Maternal prognosis was dominated by a morbidity linked by an anemia in 53.90%. Maternal lethality was 2.20%. Fetal newborn-death was 88.80%. Conclusion: Placental abruption represents an obstetrical and medical emergency by its start of brutal installation, its unforeseeable character and its materno-fetal consequences. Only a tacking of risk populations, precocious of diagnosis and a speed management in surgical and medical unit allow improving the prognosis of this disease.

Les infections des sites opératoires sont fréquemment rencontrées dans les pays en développement. La césarienne étant l'une des interventions chirurgicales la plus pratiquée chez les femmes dans le monde, nous avons initié cette étude sur les aspects épidémiologiques, cliniques, thérapeutiques et pronostiques des suppurations pariétales post-césariennes dans le département de gynécologie-obstétrique du CHU Yalgado Ouédraogo en vue de réduire leur survenue. Il s'est agi d'une étude transversale à visée descriptive menée du 1er avril 2015 au 30 septembre 2015 soit une période de 6 mois. Soixante-dix cas de suppurations pariétales ont été notés sur 1998 cas de césariennes soit une incidence de 3,5%. L'âge moyen des patientes était de 26,2 ans ± 6,1. Les patientes étaient majoritairement des femmes au foyer (77%). La césarienne a été réalisée en urgence chez toutes les patientes. La suppuration a été diagnostiquée surtout à la 1èresemaine (60%). Le germe identifié était le staphylocoque aureus dans 37,8% des cas. Une reprise chirurgicale de la paroi abdominale a été nécessaire dans 34,3% des cas. L'évolution a été favorable chez toutes les patientes. La suppuration pariétale post césarienne reste fréquente. La prise en charge nécessite parfois une reprise chirurgicale. Une meilleure identification des facteurs favorisant cette affection par d'étude plus poussée pourrait permettre de réduire de façon significative leur incidence et par conséquent améliorer le pronostic maternel.

Background Abdominal pregnancy is defined as the partial or total insertion of the embryo into the abdominal cavity. It is rare, and can evolve towards the full term if it is not recognized in the early pregnancy. It carries a high risk of maternal-fetal morbidity and mortality. Case presentation We report a case of a 22 year-old gravida IV, para II with an asymptomatic and undiagnosed abdominal pregnancy presumed full term, in a context of health centers under-equipment. She had attended 5 routine antenatal care, but had not performed any ultrasound scan. She had been transferred from a medical center to the Hospital of Ouahigouya (Burkina Faso) for bowel sub-obstruction and intrauterine fetal death, with failure of labor induction. On admission, the hypothesis of uterine rupture or abdominal pregnancy with antepartum fetal demise was considered. A laparotomy was then performed, where an abdominal pregnancy was discovered, and a dead term baby weighing 3300 g delivered. The placenta which was implanted into the ruptured isthmus of the left fallopian tube was removed by salpingectomy. Postoperative follow-up was uneventful. Conclusion This case report exposes the necessity for the practitioner to think about the possibility of abdominal pregnancy in his clinical and sonographic practice, irrespective of the gestational age, mainly in contexts where there is under-equipment of the health centers.

Context: The use of hormonal contraceptives could lead to a rise in blood pressure with an onset of hypertension. The objective of the study was to describe the epidemiological, clinical and therapeutic patterns of hypertension occurring in women on hormonal contraception. Patients and Methods: A retrospective study was carried out over a period of 5 years. It involved clients on hormonal contraception who developed hypertension during follow-up at the Family Planning Unit of the Yalgado Ouedraogo Teaching Hospital in Burkina Faso. Results: The global frequency of hypertension in clients on hormonal contraception was 1.8%; it varied depending on the type of methods of contraception used; it was 4.2% for clients on oral combined pills, 1% for implant users and 0.97% for women on injectable. The mean age of patients was 35.6 ± 8.4 years. Sixty-seven patients (84.8%) had mild to moderate hypertension. The mean time to onset of hypertension was respectively seventeen (17), thirty six (36) and thirty eight (38) months for patients on OCPs, CIP, and implants. After the discovery of hypertension, the contraception methods have been changed in 75.9% of cases, stopped in 5.2% of cases and the same contraception method was continued in 8.9% of cases. None of the patients who continued the same contraceptive method had obtained a normalization of blood pressure. Blood pressure was normalized in 48.6% of patients who have changed contraceptive methods. The average time of normalization of the blood pressure varied from three to five months, depending on the method that induces the hypertension. Conclusion: Hypertension on hormonal contraception is not uncommon. It is important to assess the risk factors for its occurrence at the initiation of contraception.

Spontaneous bilateral ectopic gestation is very rare. The authors report a case diagnosed and taken care of at Yalgado Ouedraogo Teaching Hospital, Ouagadougou. It was a 30-year-old patient with no known pathological history. She had presented at the obstetric emergencies with a state of hypovolemic shock by haemoperitoneum with digestive disorders, pelvic pain, vaginal bleeding, and a mention of delayed menstruation. The ultrasound coupled with the urinary immunological pregnancy test confirmed the diagnosis of ruptured ectopic pregnancy and a bilateral form was suspected. A laparotomy in emergency confirmed the diagnosis of bilateral ectopic gestation with a right ampullary unruptured pregnancy and a left isthmic ruptured gestation. A bilateral salpingectomy was performed and counseling was made for the use of medical help of procreation in case of future need of pregnancy.

The Society of Gynaecologists and Obstetricians of Burkina Faso (SOGOB) conducted a project to reinforce skills in respectful maternity care among its members and health workers at three facilities. The participatory process allowed health workers to self-diagnose quality of care, recognize their own responsibility, propose solutions, and pledge respectful care commitments that were specific for each unit. Key commitments included good reception; humanistic clinical examination; attentive listening and responsiveness to patient needs; privacy, discretion, and confidentiality; availability; and comfort. These commitments can potentially be modified after each evaluation by SOGOB. Poor working conditions were found to negatively impact on quality of care. High staff turnover, frequent technical malfunctions, and inadequate infrastructure were identified as issues that require future focus to ensure improvements in quality of care are sustainable. Programs that aim to improve the maternity experience by linking good practice with humanistic care merit rollout to all healthcare facilities in Burkina Faso.