Les éclampsies en centre hospitalier universitaire en Côte d’Ivoire: prise en charge, évolution et facteurs pronostics

Abstract

Objectif : Analyser les aspects thérapeutiques et évolutifs de l'éclampsie en milieu de réanimation en Côte d'Ivoire. Résultats : L'étude a porté sur 313 patientes dont l'âge moyen était de 22,7 ± 6,1 ans. Le diazépam était l'anticonvulsivant le plus utilisé (50,5 % des cas) et la dihydralazine l'hypertenseur le plus fréquemment employé (50,2 %). L'accouchement a été réalisé par césarienne dans 58,5 % des cas et par voie vaginale dans 41,5 % des cas. Pour la césarienne, l'anesthésie générale avec intubation a été réalisée dans 79 % des cas et la rachianesthésie utilisant la bupivacaïne 0,5 % (dose: 10 à 12,5 mg) dans 21 % des cas. Le traitement n'a pas été régulièrement suivi dans 31,3 % des cas. La mortalité maternelle s'élevait à 16 % et la mortalité périnatale à 16,1 %. La provenance hors du CHU, le délai d'admission > 12 h, le score de Glasgow ≤ à 8 à l'admission, l'état de mal éclamptique et le suivi irrégulier du traitement étaient les facteurs prédictifs de mortalité. MéthodeConclusion : La mortalité maternelle est encore élevée dans notre contexte. Une action énergique sur les facteurs de mauvais pronostics permettra de réduire la mortalité.

Maternal mortality from eclampsia in developing countries: some progress, but still a major challenge

“…Coccody and Yopougon are, however, two of only three university teaching hospitals in that country, reminding us of the limited access to health care in Western Africa, and especially in Côte d'Ivoire, where maternal mortality rates remain amongst the highest in the world (> 600 per 100,000 live births). 6 The data presented in the paper by Brouh et al 1 may leave us with mixed feelings. on one hand, some features of hospital care seem very similar to what can be seen in more developed countries, such as a high number of Cesarean deliveries, large numbers of patients receiving mechanical ventilation, and ready availability of low molecular weight heparins.…”

“…EAdERS of the Journal will probably be surprised by the contents of the article by Brouh et al 1 published in this issue, which describes maternal mortality and intensive care unit (ICU) events of pregnant patients in Western Africa. Most readers are probably much more familiar with reports on maternal mortality from Western countries, including the Confidential Enquiries on maternal deaths in the United Kingdom (UK), 2 the French Report on Maternal deaths, 3 or descriptions of maternal deaths in the United States.…”

“…A more recent development in some countries is that obstetric patients can be admitted to ICUs. This level of care is now available in the capital of Côte d'Ivoire, Abidjan, as described by Brouh et al 1 Although Côte d'Ivoire is considered to be part of Sub-Saharan Africa, it is located in its western part, and has a health care coverage which is slightly better that most of its neighbouring countries. Coccody and Yopougon are, however, two of only three university teaching hospitals in that country, reminding us of the limited access to health care in Western Africa, and especially in Côte d'Ivoire, where maternal mortality rates remain amongst the highest in the world (> 600 per 100,000 live births).…”

“…Indeed, in most other trials, maternal mortality associated with eclampsia was much lower than the 16% incidence reported here. 1 In the Collaborative Eclampsia Trial which evaluated women who had already had eclamptic seizures (secondary prevention), mortality was 5.1% in the control groups (receiving either diazepam or phenytoin).…”

“…2 The authors should be commended for reporting their experience from Côte d'Ivoire, relating to maternal mortality secondary to eclampsia, and for analyzing the associated risk factors in that setting. Brouh et al 1 have identified both medical and health systems barriers to reducing maternal mortality from eclampsia. Identification of these barriers is the primary step to begin reducing maternal death rates in their country.…”