Analysis of Patient Evacuations at the Centre Hospitalier Universitaire Communautaire (CHUC), Central African Republic

Obstetric complications are the main cause of mortality and morbidity. Many factors limit women’s access to the quality care they need to reduce this mortality. We proposed to analyse our referral system to identify certain factors that may limit its proper functioning and contribute to maternal deaths. This was a 12-month descriptive and analytical cross-sectional study of 259 evacuated women. The average age was 28.8 ± 7 with extremes ranging from 15 to 44 years. Most of the women were single (81.5%), accompanied by medical staff (78.8%), and had a venous approach (81.9%). The means of transfer used were ambulance (78.8%) and motorbike (11.6%). The transfer time was less than one hour (40.9%). The reasons for referral were consistent with the definitive diagnoses (64.5%) and diagnostic errors were noted (35.5%). The majority of patients were treated surgically (77.6%). We recorded maternal death (7.7%), due to unqualified personnel, transfer time, and poor general and haemodynamic condition (P < 0.05). The causes of death were abortion, ectopic pregnancy, arterial hypertension and post-partum haemorrhage (P = 0.014). Fresh stillbirths (14.9%), newborns transferred to neonatology (57.7%). Counter-referrals were assured (46.7%). Reducing diagnostic errors and late evacuations, as well as ongoing training for providers in peripheral health facilities on the signs of serious obstetric and neonatal emergencies will help to reduce the frequency of evacuations.