Obstetrical Emergencies in Teenagers at the Reference Health Centre of Commune VI, District of Bamako, Mali

Introduction: In Mali, the adolescence is characterized by a precocious sexuality, early marriages, immature pregnancies and/or some unwanted pregnancies, and some clandestine abortions. We have undertaken this study in order to study the obstetrical emergencies in the admitted teenagers in the gynecological-obstetrical service of the reference health centre of Commune VI, district of Bamako. Material and Methods: It is a descriptive transversal study with prospective data collection in a period of six months. The studied variables were socio-demographic, admission, taking care, morbidity, and maternal-perinatal mortality. Results: Our study has recorded 300 obstetrical emergency cases in teenagers in a total number of 884 teenagers admitted for emergency in the service, or a frequency of 33.9%. 96.7% of adolescents were older than 16 years old and 3.3% were less than 15 years old. The teenagers who are not at school represent 123 of 3000, or a rate of 41%, followed by those who are in primary school with 96 teenagers, or 31%. The teenagers were married in 88.3% of cases, single in 11%, and widowed in 0.3% of cases. Housewives were 70.3% and pupils or students in 25% of cases. Those who had any medical antecedents were 99% of cases (267/300). On the other hand, 3.3% had a previous caesarean (100/300) and 0.3% a previous laparotomy (1/300). They were primigenous (75.5%), primiparous (75.7%), had a past abortion in 4% of cases, and had used contraceptive methods, either 7.7%. The dystocies were the obstetrical emergencies the most represented with 32.3% (97 cases), with 4 cases of uterine breaking, followed by acute fetal pains 21% (63 cases). Pre-eclampsia and eclampsia 20.7% (62 cases), HPP 9.7% (29 cases), and HRP 8% (24 cases). The adolescents who had caesarean birth were 58.7% and natural birth 41.3%; the caesarean indications were dominated by the dystocy (66%) followed by acute foetal pain (13.2%). The maternal prognosis was marked by 14.7 complications, with immediate post-partum haemorrhage (45 cases) at a frequency of 15%, and we recorded 5 death cases, i.e., 1.7%. The causes of death were eclampsia (2), uterine breaking (1), uterine inversion (1) and retro-placenta hematoma (1). The carried-out surgical gestures were the suture of weak parts (50%), the Caesarean (41%), historiography (3 cases) and hysterectomy (2 cases). For prenatal prognosis, the Apgar score was less than or equal to 7 in the first minute in 13.1%. Newborn babies with low birth weight represented 23.6%. The low weight was due either to prematurity or hypotrophy. Our reference rate was 38.7%; the motives of references were such as: prenatal asphyxia with a rate of 56% of referred newborn babies, 21.6% for hypotrophy, 15.5% for prematurity, 4.3% for neonatal infection, 1.7% for macrosomia, and 0.9% for malformation (omphalocele). We must note that 89.5% of newborn babies were alive at birth, while 10.5% were stillborn. We have recorded 23 cases of neonatal death, or 8.6%, all precocious, by perinatal asphyxia (18), prematurity (4), and omphalocele (1). Conclusion: Obstetrical emergencies among teenagers were frequent in the gynecological-obstetric service of the CSREF of Commune VI. They were dominated by dystocia and pre-eclampsia/eclampsia. The maternal prognosis was dark, with a high lethality (1.7%); the prenatal prognosis was marked by strong mortality.