TITLE:
Contribution to the Study of Hemorrhages in the Third Trimester of Pregnancy, Etiology and Management
AUTHORS:
Seydou Mariko, Pierre Coulibaly, Bréhima Traoré, Nanko dit Seydou Bagayogo, Souleymane D. Sanogo, Tiounkani Augustin Théra, Mamadou Traoré, Nanko Doumbia
KEYWORDS:
Hemorrhage, Pregnancy, 3rd Trimester, Management, Prognosis
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.12 No.4,
April
29,
2022
ABSTRACT: Third trimester bleeding is
a common concern in obstetrics. The main objective of this work was to study
the management of hemorrhages in the third trimester of pregnancy in the
maternity ward of the Sominé Dolo hospital in Mopti. Our prospective
descriptive cross-sectional survey type study conducted at the maternity ward
of Sominé Dolo hospital in Mopti over a period from January 1, 2017 to December
31, 2017 included 94 cases collected. During this period we had performed 1485
deliveries including 94 cases of pregnancies complicated by 3rd trimester
hemorrhage, a frequency of 6.33%. The main cause of hemorrhage in the third
trimester was represented by placenta preavia 42.6% followed by retroplacental
hematoma 28.7%, uterine rupture 26.6% and association Placenta preavia and
retroplacental hematoma 2.1%. The type of intervention depended on the cause of
the hemorrhage and the maternal and fetal condition. More than half of the
cases of uterine rupture 52% had benefited from a hysterorrhaphy during a
laparotomy (n = 13/25) against 48% from hysterectomy (n = 12/25). Caesarean
section was performed in 87.5% (n = 35/40) against 12.5% vaginal delivery (n = 5/40) in case of placenta
preavia. In the end, in 74% of cases (n = 20/27) of retroplacental
hematoma, first-line cesarean section was performed. The maternal prognosis was
represented by a mortality rate of 12% (n = 11/94) and morbidity dominated by
hypovolemic shock 48.9% (n = 22/94), infections 28.8% (n = 13/94) and
coagulopathy 11.1% (n = 5/94). The fetal prognosis was very poor. More than
half (55%) of the newborns had succumbed against 45% of the newly born. In
55.3% of cases neonatal mortality occurred antenatally. Neonatal morbidity was
represented by prematurity, i.e. 20.2% (n = 19/94) and low birth weight, i.e. 22.3% (n = 21/94).