During the study period we collected 361 cases of gynecological and obstetrical emergencies out of a total of 1779 consultations, i.e. a frequency of 20.29%.

Obstetrical emergencies largely dominated with 91.41% and gynecological emergencies represented 8.59% (Table 1).

The average age of patients was 29.5 with extremes of 14 and 47. The average parity was 1.9 with extremes of 0 and 11 years. Housewives and the uneducated were the most numerous. Most of our patients were married.

More than half of the patients were evacuated (56.70%) compared to 43.3% who came on their own.

The transfer was not medicalized in any of the 100% cases and was done by public transport or in a private car. No venous lines were taken.

More than half of the patients (53%) received between 1 and 3 ANCs, 24.4% more than 4 ANCs and 22.3% no ANC (Table 2).

In more than half of cases abdominopelvic pain was the reason for admission.

The general condition was considered satisfactory in 84% of cases and poor in

16% of cases (Table 3).

Obstetrical emergencies were dominated by an acute fetal distress and hemorrhage in the last quarter of the pregnancy.

Gynecological emergencies represented 8.59% and were dominated by hemorrhagic abortions, followed by a cataclysmic rupture of the ectopic pregnancy, the hemorrhagic fibromyoma and the ovarian cyst torsion.

We recorded 271 cases of caesarean sections out of 330 obstetrical emergencies, i.e. a rate of 82.12%.

In our series, 12% of patients were transfused for severe anemia. All patients received crystalloids (lactated Ringer’s or isotonic saline), colloids (macromolecules) in 62.2% of cases. The antibiotic therapy was systematic in all patients, in most cases 1 g injectable ampicillin was associated with 500 mg infusable metronidazole. Hypertensive attacks were treated with alpha methyldopa and injectable nicardipine. Magnesium sulfate was used to treat or prevent seizures in 43.6% of cases.

In addition to the caesarean section (82.12%), an exploratory laparotomy was performed either for uterine rupture in 3.6% of cases, ectopic pregnancies in 2.49%, hemorrhagic fibromyoma in 1.94%, cyst torsion in 1.39%. Eight hysterectomies for hemostasis were performed, i.e. 2.21% for the worsening of hemorrhage. Laparoscopy was not performed due to the lack of equipment.

Regarding the management of abortions, manual intrauterine aspirations were performed in 2.77% of patients. A uterine revision was necessary in 17.3% of cases.

The average length of hospitalization was 3.2 days with extremes of 1 and 17 days.

We recorded 19 cases of maternal death, i.e. a maternal lethality of 5.26%. Causes of death were dominated by hemorrhage, 16 cases out of 19, i.e. 84.21%. Other causes were represented by complications of vasculorenal syndromes, 3 cases out of 19, i.e. 15.79%. All cases of death were related to obstetrical emergencies.

The perinatal mortality was 30.3%.

Gynaecological and obstetrical emergencies were frequent in our study. These emergencies were essentially obstetrical (91.41%) with an acute fetal distress as the main entity in our setting, followed by last pregnancy quarter hemorrhage. This high frequency of gynecological and obstetrical emergencies in our series could be explained by the fact that the university clinic of gynecology and obstetrics of the Donka National Hospital is the largest hospital in the country intended to receive all the severe cases evacuated. by peripheral health structures and birthing centers in Conakry.

Our frequency is much higher than those observed in Togo (2.65%) [7] and in Gabon (3.15%) [8].

It is also higher than those observed in other studies [1] [9] [10] [11] [12]. The high proportion of obstetrical emergencies was due not only to the geographical location of Donka maternity hospital in relation to the 4 urban communes of Conakry, but also to the high number of complicated deliveries evacuated to the maternity hospital of Donka. Gynaecological emergencies represented 8.59% and were dominated by haemorrhagic abortions, followed by the cataclysmic rupture of ectopic pregnancy, haemorrhagic fibromyoma and ovarian cyst torsion. These complications were mainly related to the late discovery of these various pathologies. All cases of ectopic pregnancy were received in a cataclysmic rupture picture with peritoneal flooding.

The average age of patients was 29.5 with extremes of 14 and 47. Tchaou B A et al reported an average age of 26.7 ± 6.2 with extremes of 15 and 45 [2].

For Kadima M C et al. the 20 - 35 age group was the target of obstetrical emergencies with 77.63% of cases, the average age was 29.19 [6].

For Samaké et al. the average age was 26 with extremes of 15 and 44 [13].

Andriamudy C L et al. reported extremes of 15 and 48 with an average age of 29 [14].

Sépou A et al. found an average age of 24 with extremes of 13 and 60. In the latter study, gynecological pathologies were included [15].

The average gestational age was 2.9 with extremes of 0 and 12.

For Samaké A et al., primiparous women represented 60.4% of the sample and multiparous women 39.51% for an average parity of 4 with extremes of 1 and 14 [13].

Tchaou B A et al. reported an average gestity of 3.2 ± 12.16 [2].

At the University Hospital of Brazzaville, admissions to gynecological and obstetrical emergencies were more represented by primiparous women (42%) [16]. In their series, primiparity was associated with pre-eclampsia and eclampsia in most of the cases admitted.

In Benin, multiparous women (34.59%) and primiparous women (27.83%) were in the majority.

The high percentage of nulliparous and primiparous women among obstetric emergencies also confirms the notion of risk of gravidopuerperium in young women. It is in this group that a high frequency of vasculorenal syndromes and mechanical dystocia is observed. Thus, gravidopuerperium in this category of pregnant women is marked with obstetrical problems due to the immaturity and the inexperience of primiparous women on the one hand, and the fragility of the uterus of multiparous women on the other [9] [17] [18].

More than half of the patients were not educated (52.08%). A high level of education would help to understand the usefulness of prenatal consultations in the detection and the prevention of complications. Early detection of EPs allows therapeutic actions to be taken to avoid cataclysmic rupture.

In 53% of cases, patients admitted for obstetrical emergencies received between 1 and 3 ANCs. Most pregnancies with obstetrical emergencies were poorly followed up. Prenatal consultations were not of good quality.

This observation was also made in Gabon in Libreville where the average ANC was 2 ± 1.8 [12].

We note that most of these parturient with obstetrical emergencies did not receive any ANCs and showed up only during labor. Although prenatal monitoring is an effective preventive activity that improves the outcome of the pregnancy, the number of ANCs is not sufficient and quality must be added to improve the effectiveness of prenatal monitoring [1].

Clinically, abdominopelvic pain of the UC type and hemorrhage were the main reasons for consultation.

The diagnoses of severity on admission were mainly acute fetal distress and hemorrhage in the last quarter of the pregnancy.

For Tchaou B A et al., signs of clinical severity on admission were: hypertensive crisis (21.1%), hyperthermia (12.3%), anemia (11.2%), shock (5.4%), coma (3.8%), seizures (1.4%) and jaundice (1%) [2].

In terms of treatment, our patients received either a medical, an obstetrical or a surgical treatments or both or all three of them at the same time.

In the Tchaou B 17 series, 5% of patients received transfusions for severe anemia and 60.2% of patients received vascular filling. Hypertensive crises were treated with Nicardipine in 12.2% of cases. Magnesium sulfate was used to treat or prevent seizures in 9.3% of cases. Three hundred and thirty-seven deliveries were performed, 53.4% by vaginal delivery and 46.6% by cesarean section. One case of caesarean section was followed by a hysterectomy for delivery hemorrhage due to uterine atony. In addition to cesarean sections, 12.9% of patients underwent laparotomy either for an extra uterine pregnancy (12.4%) or for pelviperitonitis (0.05%) [2].

Maternal case fatality in our series was 5.2%. Our rate was higher than the 2.63% reported by Kadima M C [6].

Our rate, although high, is lower than those found in other African countries: 13.08% in Mali [6], 13.11% in Togo [7], 5.79% at the University Hospital of Bouaké in Côte d'Ivoire with uterine rupture [9].

The main causes of these deaths were related to hemorrhage. The poor general condition of patients, aggravated by the conditions of transfer, could be the explanation for the high rate of maternal mortality in our environment.

The perinatal prognosis was severe in our study (30.3%). Indeed, this rate remains high compared to those of the authors: 15.44% at the CNHHU of Cotonou [12], 11.6% at the CHU of Cocody of Abidjan [10].

It should be noted that higher rates are reported in the literature, particularly in the series of the maternity hospital of the Malagasy District where it was 51.57% [1] and in that of the regional hospital of Sokodé in Togo, 52.45% with a very high prevalence of uterine rupture (83.33) and HRP (80%) [7]. In Bouaké, the perinatal prognosis was catastrophic with 92.6% of fetal death during uterine rupture [9].

Our high rates of maternal and perinatal deaths could be explained not only by the poor health coverage of the country in quality emergency obstetric and neonatal care but also by the three delays leading to death.

We also note a poor organization of the referral.