In total, 647 blood transfusions were performed out of 3971 obstetric emergencies, representing a frequency of 16.3%. This high frequency can be explained by the significant prevalence of obstetric hemorrhages in low-resource countries, where care conditions are often suboptimal.

Socio-demographic data from transfused patients showed that the majority (68.62%) were between 20 and 34 years old. The average parity was 4.3, with a range of 1 to 11 births. The majority of patients (85.78%) were unemployed. Married patients accounted for 88.1% of transfused cases, demonstrating a strong correlation between marital status and the need for transfusion, as shown in Table 1 .

The main indications for blood transfusion were: anemia following postpartum hemorrhage due to uterine atony (37.7%), nutritional anemia (15%), and retained placenta complicated by hemorrhage (13.9%). Other complications such as soft tissue tears and coagulation disorders are also frequent causes of transfusion in obstetrics, as shown in Table 2 .

The most commonly used blood products were whole blood (50.5%), packed red blood cells (21.2%), and fresh frozen plasma (18.1%). Requests for massive transfusions (4 - 5 units) were made for 564 patients and were actually administered in 18.33% of cases. This underscores the importance of having sufficient quantities of blood products available to manage severe obstetric hemorrhages, as shown in Table 3 .

The average length of stay in the service was 14.5 days with extremes of 1 and 21 days.

Maternal morbidity and mortality: We observed transfusion-related incidents: acute pulmonary edema (5 cases), anaphylactic shock (4 cases), hyperthermia-chill syndrome (3 cases), urticaria (3 cases), and lumbar pain (2 cases). We recorded 18 maternal deaths during this study. These deaths were related to either the absence of blood, insufficient blood, or delayed blood acquisition. Perinatal and neonatal mortality: out of a total of 231 newborns, we recorded 77 stillbirths including 12 macerated, 12 newborns with a morbid Apgar score, 9 of whom died in the neonatal period.

The rate of blood transfusions observed in this study was 16.3%, which is similar to results reported in other studies conducted in Africa. For example, Ilunga et al. [6] reported a rate of 16% in a study in the Democratic Republic of Congo, while other research in sub-Saharan Africa indicates rates ranging from 5.7% to 26.1% depending on the context. This high rate in our study can be explained by several factors: malnutrition, poor management of postpartum hemorrhage, and inadequate quality prenatal care. Blood transfusion thus becomes a necessary solution in situations where other interventions fail or are inaccessible. Furthermore, preventive management of obstetric hemorrhage, through strategies such as iron supplementation and the administration of preventive malaria treatments, would have reduced the rate of these transfusions. These results highlight the importance of more proactive obstetric care in resource-limited regions [1] [4] .

Socio-demographic data from the study reveal that young women, aged 20 to 34, are the most frequently transfused, representing 68.62% of cases. Transfusions primarily affected patients engaged in non-income-generating activities (p = 0.000; OR = 1.29; CI = [1.24 - 1.34]), those with no formal education (p = 0.51; OR = 1.01; CI = [0.98 - 1.04], and especially those who were married (p = 0.000; OR = 3.52; CI = [3.30 - 3.76]). Ilunga N.H. [6] reports that 60% of transfused patients had a secondary education. This finding is consistent with previous studies, notably that of Ilunga et al. [6] , who observed a similar prevalence in this age group. The high parity of the patients (mean of 4.3) indicates that women who have already had several children are more likely to experience major obstetric complications requiring blood transfusions. Women engaged in non-income-generating activities Paid women (85.78%), primarily from lower socioeconomic backgrounds, are also more affected. This factor could reflect inequalities in access to healthcare, particularly prenatal care. Married women (88.1%) also represent a significant proportion of transfused patients, which could be linked to social and cultural factors influencing access to care. The management of obstetric emergencies in these populations requires particular attention to improving access to care in rural and less accessible areas [7] [8] .

Uterine atony (37.7%) remained the leading cause of blood transfusion in this study. This condition, which often occurs after delivery, is a major cause of postpartum bleeding and one of the most frequent obstetric emergencies. Previous studies also report this indication as the most frequent in sub-Saharan Africa [4] [9] , confirming the importance of active management of postpartum hemorrhage. Retained placenta (13.9%) and nutritional anemia (15%) were also common indications. Anemia, in particular, represents a major health problem, affecting a significant number of pregnant women in developing countries, where iron and folic acid supplementation is often insufficient. The results also highlight that coagulation-related complications, such as bleeding due to coagulation disorders, require transfusions of plasma and specific blood products. Previous studies, such as that by WHO/CDC [10] and Boukooungou [11] , indicate that the management of postpartum hemorrhages by transfusion of blood products adapted to the clinical situation improves the obstetric and maternal prognosis.

Whole blood was used in 50.5% of patients, while packed red blood cells were administered in 21.2% of cases. Fresh frozen plasma was used in 18.1% of cases, reflecting appropriate management of blood product requirements based on clinical indication. The diversity of transfused products underscores the importance of appropriate blood stock management in hospitals, particularly in resource-limited settings where the availability of specific blood products may be restricted. Previous studies [12] - [14] have also highlighted that using blood products tailored to each patient’s condition not only improves clinical outcomes but also reduces the risk of transfusion complications. More rigorous blood stock management, coupled with improved training for medical staff, could further enhance the effectiveness of blood transfusion in obstetrics.

Maternal prognosis is a key indicator in the management of obstetric emergencies, particularly those requiring blood transfusion. In this study, a number of maternal complications were observed, including transfusion reactions and maternal deaths. Despite efforts to meet transfusion needs, maternal mortality remains a major problem in settings with limited access to care. The observed transfusion reactions included cases of acute pulmonary edema (5 cases), anaphylactic shock (4 cases), and hyperthermia-shivering syndrome (3 cases), as well as other minor adverse reactions. These complications are related to factors such as the quality of blood products used, transfusion management, and medical staff training [10] . Proper management of blood products and the implementation of rigorous transfusion protocols are essential to minimize these risks. Regarding maternal mortality, this study recorded 18 deaths, representing approximately 2.78% of transfused patients. These deaths are primarily linked to the complete absence or inadequacy of blood transfusions, or to delays in providing the necessary blood products. This finding aligns with results observed in other African studies, where maternal mortality due to obstetric hemorrhage remains high in the absence of adequate and timely blood transfusions [4] [9] [15] . Rapid and effective management of severe hemorrhage is crucial for maternal survival. Improved blood stock management, optimized transfusion procedures, and ongoing training for healthcare teams could significantly reduce maternal mortality rates. Prompt and appropriate management of obstetric emergencies could also reduce the risk of transfusion reactions and improve the prognosis. Fetal prognosis is also severely affected by maternal complications, particularly severe hemorrhage requiring blood transfusions. This study revealed a neonatal mortality rate of 9 neonatal deaths among 231 newborns, representing a neonatal mortality rate of 3.89%. Furthermore, 77 stillbirths were recorded, 12 of which were macerated, indicating that delayed or inadequate management of obstetric emergencies also has a direct impact on fetal prognosis. Newborns of mothers who received transfusions for severe obstetric hemorrhages generally have an increased risk of neonatal complications, particularly due to adverse conditions related to prematurity, infections, and hypoxia [16] . Factors associated with these adverse outcomes include delayed management of maternal hemorrhage, lack of availability of blood products, and transfusion complications, which can lead to circulatory instability in the mother, directly affecting the fetus [14] . The results of this study highlight the importance of continuous monitoring of mothers and newborns after blood transfusions to prevent fetal complications. Improved management of obstetric complications, combined with preventive interventions and rigorous postpartum follow-up, can reduce these risks.