Audit of Obstetric Medical Evacuations at Youssou Mbargane DIOP Hospital in Rufisque, Dakar-Senegal

Abstract

Objectives: To assess the quality of the obstetric evacuation system at the Youssou Mbargane Diop Hospital in Dakar. Methods: Our study was conducted at the Hospital of Youssou Mbargane DIOP in Rufisque, a district about 26 km from downtown Dakar. This was a qualitative and evaluative descriptive study in the form of operational research aimed at improving the quality of obstetrical evacuations and resolving problems through a dynamic and team approach. It was carried out within the framework of the AQUASOU project (Improvement of Quality and Access to Emergency Obstetric Care in French). A liaison sheet was completed at the arrival of each evacuated patient, prospectively during the period from December 24 2006 to July 10 2008. The epidemiological characteristics were, origin of the evacuated, the evacuation conditions, evacuation patterns and therapeutic data. The data were collected through an Excel database developed for this purpose. The analysis was done using the Epi-Info version 6.0 software. Results: The frequency of evacuations was 23.2%. The average age of our patients was 25.3 years with extremes of 14 years and 48 years. More than half of the evacuees (59%) came from the Sanitary District of Rufisque. The majority of evacuations were made in a taxi (76.5%). An ambulance was used in 190 cases (20.6%). Seated transport was performed in 78% of cases. The transfer was medicalized in almost one-third of cases (29.3%). A liaison sheet was established during the transfer of patients in 77% of the cases. Evacuations were related to hemorrhage in 23.3%, dystocia in 22.2%, and fetal-adnexal anomaly in 17.3% of cases. No treatment was instituted before evacuation in 56% of evacuees. 48.5% of the evacuees had received treatment beyond. Conclusion: The poor quality of obstetric evacuations seems to be a brake on the decline in maternal and neonatal mortality in Senegal. Training and retraining of health personnel would improve maternal-fetal and neonatal morbidity and mortality.