うつ病と不安に関するジャーナル
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概要

Post-natal consultation at the institute hygiene social hospital in Dakar: about 2324 cases collected between 1 September 2020 and 29 February 2021

Fatou SAMB*

Objectives: To determine the frequency of post-natal consultation (PNC) and the socio-demographic and clinical characteristics of women giving birth, to assess the content of PNC in relation to recommended standards and to evaluate maternal and neonatal prognosis.

Patients and methods: This was a retrospective, descriptive and analytical study conducted over a period of 6 months (1 September 2020 and 29 February 2021) and focused on postnatal consultations at the hospital's Department of Gynaecology and Obstetrics (IHS). We studied patients' socio-demographic characteristics, antenatal follow-up data, and mode of delivery, immediate postpartum surveillance and postnatal follow-up data. Data were entered and analyzed using Excel 2010 and Epi info 7.2 software. We conducted 2324 postnatal consultations in 1134 deliveries, i.e. a coverage rate of 68.3% and an average of 2 PNC per patient. All patients had received PNC 1, 68.7% PNC 2 and 36.1% PNC. Only 396 (34.9%) patients had completed all three consultations. The average age of the women in our series was 27 years. The majority of patients lived in the Dakar department (70.55%). Primiparous women were in the majority (39%). Most patients had given birth vaginally (68.9%). Parameters such as blood pressure, pulse, vulvar bleeding and uterine globe were monitored in ¾ of patients. The average length of hospital stay for vaginal deliveries was 24 hours, and 72 hours for caesarean deliveries. Midwives performed 1056 PNC (45.4%) and obstetricians 1268 PNC (54.6%). PNC parameters were assessed in most patients, with the exception of weight, which was assessed in only 1.9% of patients in PNC 1, 27.4% in PNC 2 and 39% in PNC 3. Also in PNC 3, no patient had a speculum examination with VIA/VILI or a cervico-uterine smear. In newborns, measurements were often neglected during PNC 2 (2.1% of cases) and PNC 1 (1.5% of cases), as was the neurological examination (1.5% in PNC 2 and 15.8% in PNC 3. Exclusive breastfeeding was practiced in 78% of cases, while the remainder of the sample (22%) was mixed breastfeeding. 30.5% of patients had benefited from post-partum family planning. These were mainly caesarean patients (76.3%). The progestin-only implant was the most frequently chosen method (73.3%). Post-partum complications accounted for 10.9% of deliveries. High blood pressure was the most common, accounting for 59.6% of complications, followed by post-partum haemorrhage, which accounted for 27.4% of complications and 1.5% of deliveries. We recorded 1103 live births (94.5%), 33 fresh stillbirths (2.8%) and 31 macerated stillbirths (2.6%). One hundred and forty-three newborns (13%) had presented complications. Asphyxia (4.3%) and neonatal infections (4%) were the most frequent complications. Compliance with PNC was higher in patients who had given birth by caesarean section (p<0.01) and those who had performed 4 or more ANC (p<0.01).

Conclusion: PNC coverage could be improved among patients who gave birth at the IHS maternity unit, despite the acceptable rate we recorded. This will require raising the awareness of all those involved in maternal and neonatal care.