Place of Autologous Intraoperative Blood Transfusion in the Treatment of Broken Ectopic Pregnancy ( EP ) at the Chiphra Hospital of Ouagadougou , Burkina Faso

Objective: To describe the role of autologous regenerative intraoperative bleeding of recent intra-cavity losses over the ectopic pregnancy ruptured at the Schiphra Hospital of Ouagadougou. Methodology: It has been a cross-sectional descriptive study over a period of 18 months from January 1 2014 to June 3


Introduction
In developing countries, the prevalence of anemia is very high.Among the etiologies of that, many authors cite nutritional causes, infectious causes, traumatic causes, gynecology obstetric causes including haemorrhage and ectopic pregnancy (EP) broken [1] [2].In the same context, we are witnessing to a shortage of blood products posing the problem of the treatment of this disease [3].
In these circumstances, the technique of autotransfusion, which is to retrieve, for immediate transfusion, the blood poured into the abdominal cavity, appears as an alternative to traditional transfusion [4].The department of gynecology and obstetrics at the Schiphra Hospital in Ouagadougou, imported technique of some hospitals in the sub region including Christian Hospital Tanguiéta in Benin.
The aim of our work is to describe the experience of the obstetrics and gynecology department of the Schiphra Hospital of Ouagadougou in Burkina Faso in the management of broken ectopic pregnancy by the use of this technique very advantageous.

Methodology
It has been a cross-sectional descriptive study over a period of 18 months from The variables studied included age, occupation, marital status, geographical origin, gynecological history, clinical and para clinical at the admission and the departure of the patient.Data were collected from two structured questionnaires and were entered and analyzed using EPI-Info and MS-Excel.
We considered paucipara, patients with few previous deliveries birth to 3 times, multiparas those having between 4 and 6 births and high parity those with the number of delivery greater than or equal to 7.
The assessment of the overall condition was performed at the admission taking into account the hemodynamic status.The general condition was considered good when: • blood pressure was greater than or equal to 120/80 mmHg • pulse including 70 to 80 beats/minute • hemoglobin level at admission higher than 10 g/dl The general condition was considered bad when: • blood pressure was less than or equal to 80/60 mmHg • pulse rate greater than 100 beats/minute • hemoglobin rate at admission lower to 6 g/dl Patients with intermediate hemodynamic status to these two clinical situations were considered to have a fair condition.

Frequency
From 1 st January 2014 to 30 June 2015, we recorded 322 cases of ectopic pregnancy including 216 cases of unbroken ectopic pregnancy and 106 cases of ectopic pregnancy broken including 59 cases that met our inclusion criteria.The broken ectopic pregnancy accounted for 32.9% of all the EP and auto transfusion rate was 55.7%.

Ages
The average age was 27 years with extremes of 18 and 40 years.Figure 1 indicates the distribution of patients according to their age group.Thirty-four patients (57.6%) were under 30 years.

Occupation
Figure 2 gives the distribution of patients according to their profession.Housewives are the foreground with 39%.The other group consisted of pupils and students.

Marital Status
Figure 3 shows the distribution of patients by marital status.Married women were the majority with 34%.

Number of Childbirth
The childbirth ranged from zero to eleven with an average childbirth of 5.25.
Table 1 shows the distribution of our patients according to their past childbirth.
Forty one (69.3%)patients had number of childbirth more than 4.

Admission Pattern
Table 2 shows the distribution of patients according to the pattern of admission.

General State on Arrival
The results of the assessment are shown in Figure 4.Only 8.5% of patients had a good condition at the entrance.

Seat of the EP
Figure 5 shows the distribution of patients according to the seat of EP broken.
In eighteen cases (31.4%) the seat of the EP was another but not isthmique.

Evolution of Hemoglobin
Figure 6 shows the distribution of patients per hemoglobin.

Quantity of Self-Blood Transfused
Table 3 shows the amount of self-blood transfused.

Improved Hemoglobin
Figure 7 shows the improvement rate of hemoglobin.Thirty six (62.0%) patients had an improvement in hemoglobin of greater than 74%.

Hospital Stay
Figure 8 shows the distribution of patients according to length of stay.The duration of hospitalization was less than 10 days in 95% of patients.Table 4 shows the distribution of patients according to length of stay per site.

Complications
Maternal prognosis was marked by a case of fever or a morbidity rate of 1.9% and a post autotransfusion death case with a fatality rate of 1.9%, cases of death due to a hemorrhagic shock.We have not observed cases of jaundice or hemoglobinuria.

Epidemiological Aspects
• Frequency In our series, the frequency of autologous transfusion was 55.7%.Our results are lower than those of Obiechina [1] in Nigeria who reported anautotransfusion rate of 96.8%.They are higher than those of Jongen VH [5] in Tanzania, who found a frequency of 43.3% in five years of practice.The low rate in our study could be explained in part by our flexible inclusion criteria and secondly by the fact that the practice was still at an early stage in the context of Burkina Faso.The great period in the study in Tanzania could actually hide confounders.Stratified analysis by shorter periods may reveal a contrary result [6].

January 1
st 2014 to June 30 th 2015 in the department of obstetrics and gynecology at Ouagadougou Schiphra hospital.The team responsible for conducting the survey had first received practical training in Christian Hospital Tanguiéta in Benin.The training lasted one month included the identification of eligible blood autotransfusion, the technique of blood collection, handling equipment for autotransfusion and monitoring of the patient transfused.The population of study was constituted by the cases of broken ectopic pregnancy with autologous transfusion.Inclusion criteria included:  the theoretical lower gestational age was lower to 14 weeks of gestation  the chart of clinical haemoperitoneum, of abundance  the quality of the collected haemoperitoneum blood that is to say, well oxygenated, without clots and macroscopically normal  informed consent of the patient The exclusion criteria included:  cases of homologous transfusion  patients who refused to participate in the study  macroscopic blood Appearance not acceptable and not much interesting

Figure 1 .
Figure 1.Distribution of patients according to the age group (n = 59).

Figure 2 .
Figure 2. Distribution of patients according to the professional activity (n = 59).

Figure 3 .
Figure 3. Distribution of patients according to the marital status (n = 59).

Figure 4 .
Figure 4. Distribution of patients according to their condition at admission (n = 59).

Figure 5 .
Figure 5. Distribution of patients according to the seat of broken ectopic pregnancy (n = 59).

Figure 6 .
Figure 6.Distribution of patients according to the hemoglobin slices (n = 59).

Figure 7 .
Figure 7. Distribution of patients according t the hemoglobin improvement rates (n = 59).

Figure 8 .
Figure 8. Distribution of auto transfused patients according to hospital stay (n = 59).

Table 1 .
Distribution of the patients according to the number of past childbirth (n = 59).

Table 2 .
Distribution of patients according to the reason for admission (n = 59).

Table 4 .
Distribution of patients according to the hospitalization stay.