Facteurs Associés à la Mortalité Maternelle au cours des Ruptures Utérines à l’Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé

ABSTRACT Introduction. La rupture uterine est une tragedie obstetricale. Elle est une cause frequente de deces maternel dans le monde. Le but du travail etait d’identifier les facteurs associes au deces maternel en cas de rupture uterine. Methodologie. Nous avons effectue une etude cas-temoins avec collecte retrolective des donnees, du 1er mars 2006 au 31 decembre 2015 a l’Hopital Gyneco-Obstetrique et Pediatrique de Yaounde. Les femmes decedees des suites de rupture uterine etaient nos cas et celles qui ont survecu etaient nos temoins. Les parametres d’interet etaient sociodemographiques, obstetricaux et neonataux. Les logiciels EPI info 3.5.4 et Microsoft Office Excel 2010 ont servi a l’analyse des donnees collectees. Le calcul des rapports de cote et leurs intervalles de confiance a 95% a permis d’apprecier la force de l’association entre les facteurs etudies et la mortalite maternelle au cours des ruptures uterines. Les tests de Khi carre et exact de Fisher ont permis de comparer les variables qualitatives. La valeur de p etait significative si pu003c 0,05. Resultats. Des 73 femmes ayant eu une rupture uterine, sept sont decedees, soit un taux de letalite de la rupture uterine de 9.58%. Le seul facteur significatif independant associe au deces maternel par rupture uterine apres analyse multivariee etait la coagulopathie ORa=34,71 [ (IC a 95%:1,19-1013,95), p=0,040]. Conclusion. En cas de rupture uterine, la survenue de la coagulopathie expose au deces maternel. La disponibilite des produits sanguins pourrait reduire ce risque. RESUME Background. Uterine rupture is an obstetrical tragedy. It is a common cause of maternal death in the world. Out study aimed to identify factors associated to maternal mortality in case of uterine rupture. Methodology. This was a case control study with a cross-sectional shutter and retrolective data collection from March, 1st 2006 to December, 31st 2015, conducted at the Yaounde Gyneco-Obstetric and Pediatric Hospital. The women who died of uterine rupture were the cases and those who survived were witnesses. The variables of interest were sociodemographic, obstetric and neonatal characteristics. The Epi Info 3.5.4 software and Microsoft Office Excel 2010 were used for the analysis of collected data. The calculation of the Odds Ratios and their 95% Confidence intervals was used to assess the strength of association between factors studied and maternal death the uterine ruptures. The Chi square and Ficher’s exact test were used to compare categorical variables. The P value was considered significant when pu003c 0.05. Results. Of the 73 women with uterine rupture, seven died, giving a lethality rate of uterine rupture of 9.58%. The only factor significantly associated with maternal death in case of uterine rupture after multivariate analysis was coagulopathy ORa=34.71[(95% CI: 1.19-1013.95), p=0.040]. Conclusion. The occurrence of coagulopathy in the presence of uterine rupture increases significantly the risk of maternal death. Blood products must be available to reduce the risk.