Maternal-Fetal Prognosis of the Prophylactic Cesaarian versus Emergency Cesaarian at the Reference Health Center of Commune V of Bamako District, Mali

Objectives: The goal was to assess the risk factors for emergency cesarean section versus prophylactic caesarean section. Materials and Methods: This was a descriptive analytical cross-sectional study of the Type Cas/Witnesses at the Reference Health Centre of Commune V of the District of Bamako in Mali. The sample consisted of 100 cases for 200 controls (1 case for 2 controls) with retrospective collection of data for the period from January 1 to July 11, 2011 (6 months and 11 days). Results: section indications were dominated by dystocies with 90% in cases compared to 65% in Witnesses, followed by acute fetal suffering with 30% in Witnesses. We recorded 30% perinatal deaths among Witnesses compared to 1% in Cases. We recorded 16 uterine ruptures in the Witnesses among which 2 hyste-rectomies and 14 hystererraphia. Conclusion: Prophylactic caesarean section improves maternal and perinatal prognosis more than emergency caesarean section. register reports; Newborn transfer registry; perinatal death registry; maternal death regi-stry; anaesthesia registry. variables were occupation, marital status, medical and surgical history, concept of prenatal consultation, caesarean section indications, nature of intervention, maternal-fetal prognosis.


Background
Pregnancy and childbirth have been a fatal risk to women since the beginning of times, Rivière said in 1959 [1]. This assertion of River is still relevant.
This risk that haunts every obstetrician explains the ongoing research to achieve the best pathways for a favorable outcome of pregnancy and childbirth.
In Mali, the direct estimate of the maternal mortality rate for the period 1989-1996 was 577 maternal deaths per 100,000 live births [2]. This rate is still too high despite all the current significant efforts to reduce this rate, which has hardly changed. In 2001 this rate was estimated at 582 maternal deaths per 100,000 live births [3]. Currently, the maternal mortality rate is 368 maternal deaths per 100,000 live births (EDS5 Mali 2012). Malian society continues to pay a heavy price for poor treatment of pregnancy and childbirth. Apart from haemorrhages, which account for 25%, infections15%, pre-eclampsia and eclampsia 13%, abortions 13%, dystocia occupies a significant place with 7% of direct obstetric causes [4]. As early as 1986, with the "Lower Risk Maternity" initiative, the World Health Organization (WHO) advocated that surveillance of childbirth and early detection of dystocies be taken as one of the most important approaches to reducing maternal mortality [5]. The proposal to use caesarean section to continuously improve the quality of obstetric care meets these priorities.
Whether programmed or done in an emergency, caesarean section is now a very practiced and well-controlled delivery technique. However, the risks and discomforts caused by this surgical procedure, so feared by pregnant women, should not be minimized. However, emergency caesarean section is more at risk because of the lack of preparation of the parturients and the surgical emergency. In recent years, caesarean section indications have evolved resulting in a steady increase in its frequency. This increase in frequency is related to the birth attendant's concern to give birth to the newborn in the best possible condition and a healthy mother [6]. Camara K. [7] in 2010 at the same centre found 614 caesarean sections, of which 217 were emergency caesareans, or 35.35% and 397 Is the maternal-fetal prognosis of emergency caesarean section more at risk than prophylactic caesarean section?

Objectives
The aim was to assess the risk factors for emergency cesarean section versus prophylactic caesarean section at the reference health centre in Commune V of Bamako district in Mali.

Inclusion Criteria
Cases: All patients who received a prophylactic caesarean section were included in our study. Witnesses: Any patient evacuated to the V-shared reference health centre who was diagnosed with a 4 cm cervical dilation and who was given an emergency caesarean section after the entrance examination concluded that they had been given a 4 cm cervical dilation.

The Non-Inclusion Criteria
Not included in our study were all caesarean patients in the ward who did not meet our inclusion criteria. Data collection and support: The following information was collected on the following documents: birth registry; C-section registry;

Data Analysis
The data was entered and analyzed on the Epi-Info version 6.04 software in accordance with the formula applicable to the case/control study. The statistical test used was the Odds ratio (OR) to study associations between variables. The probability (p) was determined with an alpha risk of 5%. An OR< 1 was associated with protection against the phenomenon studied; OR ≥ 2 was more synonymous with a worsening of the phenomenon studied.

Results
During the study period, out of a total of 3559 deliveries, we recorded 2794 va-

Epidemiological Aspects
The 20 -34 age group was the most represented (73%) with an average age in both groups of 27.41 years -5.84. Figure 1 shows us the distribution of patients by age. Marital status: In our study, 97% of cases were married versus 89% of Witnesses. Occupation: Housewives accounted for 52% for Cases and 73% for Witnesses. Women's residence: Most of the women in our study resided in Figure 1. Distribution of caesarean patients by age at the reference health centre in commune V of Bamako district, Mali from January 1 to July 11, 2011.  Figure 1 and Table 1.  Table 2.

The Nature of the Intervention
We recorded 16 uterine ruptures in the Witnesses (evacuated parturients); of the 16 uterine ruptures 14 had hystererrapphic and 2 had hysterectomy. None of her complications were found in the Cases (prophylactic caesarean section).

The Indications of Caesarean Section
Bone dystocia was the main maternal indication of caesarean section with 90% of our caesarean section indications in Cases versus 60% in Witnesses and acute fetal suffering was the main fetal indication of cesarean section with a frequency The nature of the procedure and the indications of caesarean sections are summarized in Table 3.

Maternal Prognosis
Post-operative complications: hemorrhagic/anaemia complications were most We did not record maternal deaths in the two groups: Cases and Witnesses.

Fetal Prognosis: Mortality and Morbidity
72.5% of The Witness's newborns were in a state of severe morbidity or born deaths (Apgar score between 0 -7) and 27.5% had a good Apgar between 8 -10 in the first year unlike the Cases, the 100% had an Apgar between 8 -10 and 1 st mn. Neonatal death: we recorded 30% of perinatal deaths among Witnesses compared to 1% in Cases. Table 4 summarizes the maternal-fetal and early neonatal prognosis and Figure 2 represents post-operative maternal complications.

Length of Hospitalization
100% of cases had a hospital duration of three days or less compared to 46% of Witnesses. 54% of Witnesses had a hospital duration of more than 3 days. The average length of hospitalization in the cases was 2.01 days −0.1 with extremes of 2 and 3 days. The average length of hospitalization for Witnesses was 4.9 days -3.1 with extrêmes de 2 et 20 jours. Figure 3 shows us the length of hospital stay.

Discussion
In the literature, Camara K. [7] in 2010 in the same centre had found 614 caesa-

Clinical Aspects
Medical-surgical history and pregnancy monitoring

The Indications of Cesarean Sections
In our study several indications of caesarean section were noted, they are either maternal or fetal. Through the evolution of caesarean section indications, monitoring (during pregnancy and labour) and improved operating conditions. The rate of high-births is becoming higher. The obstetrician, in order to give birth to "a child" in the best possible conditions while guaranteeing the life of the mother, made the indications of caesarean section much wider [6]. The most frequent

Maternal Prognosis
During our study, we recorded 16 uterine ruptures in The Witnesses (evacuated parturients); of the 16 uterine ruptures 14 had hystererraphia and 2 had hysterectomy. None of her complications were found in the Cases (prophylactic caesarean section) with p-0.0036. Camara K. [7] had found in his study 3 cases of uterine ruptures (2 hystererraphia and 1 hysterectomy). Post-operative complications: Hemorrhagic/anaemia complications were most represented, followed by infectious complications with 15.5% and 12.5% respectively in The Controls. Khlass K. [16] and Derbal S. [17] hadfound 26.3% and 20.8% infectious complications respectively. Zarouk [18] in Tunisia, Koné and Al. [19] in Mali had the highest rates of anaemia at 40.5% and 19.7% respectively. We did not find any complications in the cases: p-0.00022 OR −0.00 [0.00 -0.029]. This may be related to the fact that women are held in the Home Necks for a long time before being received in a surgical setting with sometimes complications.

Length of Hospitalization
100% of cases had a hospital duration of less than or equal to three days compared to 46% of Witnesses with a statistically significant difference of 10 -7. 54% of Witnesses had a hospital duration of more than 3 days. The average length of hospitalization in the cases was 2.01 days ± 0.1 with extremes of 2 and 3 days. The average length of hospitalization for Witnesses was 4.9 days ± 3.1 with extremes of 2 and 20 days. Tegueté I. [10] and Cissé B.
[13] reported 9.3 days and 8 days respectively. We did not record any maternal deaths.

Conclusion
Prophylactic caesarean section is a surgical procedure that improves maternal and perinatal prognosis in contrast to emergency caesarean section.