Maternal Death before Admission to the Sylvanus Olympio University Hospital Center (CHU SO): Epidemiological and Etiological Aspects

Background: In Togo, the maternal mortality rate in 2017 was estimated at 396/100,000 live births. Maternal death before admission is an increasingly growing phenomenon in the gynecology-obstetrics clinic of the CHU SO. No epidemiological data is available on the subject. Objective: Determine the epidemiological and etiological profiles of a pregnant, parturient, or woman who has given birth dead before or within 10 minutes of her admission. Methods: This was a descriptive cross-sectional study from January 1, 2014, to December 31, 2021. All maternal deaths occurring before admission and within 10 minutes of admission to the clinic were included in the study of gynecology and obstetrics at CHU SO. The data were processed by Epi info version 7 software. Results: In total, 654 maternal deaths, including 153 maternal deaths before admission, were recorded, corresponding to 23.4% of all maternal deaths. The median age was 30.2 years. 37.2% of women were uneducated. 41.2% were resellers. 79.1% of women were cohabiting. 47.1% of women had performed less than 3 ANC. 43.8% of the women who died had completed their ANC in a medical center. 54.3% by a midwife, 37.3% by unqualified personnel. 62.7% of deaths occurred postpartum and 36.3% during pregnancy. 79.1% were referrals. 88.9% of the women who died arrived in a non-medical taxi car. Among the 57 patients who died during their pregnancy, 40.3% were carrying a pregnancy of 28 to 36 weeks, and 36.3% were full-term pregnancies. Among the 96 women who died postpartum, 93.3% had given birth vaginally. Among the 121 referrals, 34.7% came from a birthing center, 56.2% were referred by a state midwife and 30.6% by unqualified personnel; 46.3% were referred without a reference form, 94.3% were referred without venous access. In 10.7%, the reason for evacuation was bleeding from the delivery, with an average evacuation time of one-hour 5minutes. 60.3% of women who died had an evacuation delay of more than one hour. 94.8% of patients died of direct obstetric causes, including immediate postpartum hemorrhage in 60.1% of cases. Conclusion: Deaths before admission constitute an increasingly growing problem at CHU SO. A late referral is a determining factor in maternal deaths before admission.