During our study, we recorded 2627 admissions. Delays in the management involved 216 patients that to say 8.2% of admissions. In total 56.5% of patients were admitted between 6 a.m and 6 p.m and 43.5% between 18 hours and 6 hours.

・ Age

The average age of patients was 26.6 ± 6.2 years with extremes ranging from 16 and 46 years. The age group 20 to 29 years was highest with 30% of patients.

・ Socio-professional status

Housewives accounted 65.3% of the sample, women in the informal sector accounted 17.5%.

・ Level of instruction

Patients with a primary level of study represented 50% of the sample, those with high school 25.9%, those without educational level 16.7% and the upper level 7.4%.

・ Marital status

Patients living in a conjugal relationship represented 55.1% of the sample, those cohabiting represented 38.8%, the unmarried represented 5.6% and widows represented 0.5%.

・ Parity

Nulliparous women represented 32.9% of the sample, 26.9% of primiparous, 35.1% of pauciparous, 4.1% of multiparous and 0.9% of high parity.

・ Provenance of patients

In total 81% of the patients were from the city of Ouagadougou and 19% of surrounding communities.

・ Admission mode

Patients had been referred in 85.7% of cases, transferred from another department of the UTH-YO in 0.5% of cases. In 13.8% of cases, they had consulted directly at the UTH-YO by self-reference.

・ Mode of transport

In 63.9% of cases, they were admitted by ambulance, 15.7% in private car, motorcycle in 8.8%, 7.4% in a taxi.

・ Qualification of the health worker having referred the patients

The patients had been referred by a midwife in 59.7% of cases, by a physician in 39.8% of cases and by a nurse in 0.5% of cases.

・ Obstetric admission pattern

The distribution of patients according to the reason for admission was presented in Table 1.

・ Waiting period between admission and installation on the examination table

The average waiting period to install a patient on the examination table was 10.9 ± 0.7 minutes with extremes of 1 and 57 minutes.

・ Waiting period between installation of the patient and the beginning of the clinical examination

The average waiting period between the installation of the patient and the beginning of the clinical examination was 4.5 ± 0.6 minutes with extremes of 1 and 45 minutes.

・ Waiting period between clinical and early first aid

*others: 1 cases of detention of dead egg, 1 pelvic trauma cases, 1 cases of threatened miscarriage, 1 cases of uterine rupture and 1 cases of snakebite envenomation.

The average waiting period between the clinical examination of the patient and the beginning of first aid was 127.2 ± 13.6 minutes (2 h 7 min) with extremes of 2 minutes and 533 minutes (8 h 53 min).

・ Waiting period between arrival and start of first aid

The average waiting period between the arrival of a patient and the beginning of first aid was 142.7 ± 13.5 minutes (2:23 min) with extremes of 16 and 546 minutes (9:06 min).

・ Qualification the health worker having welcomed the patient

The patient was greeted by a trainee interned in 88.9% of cases by a midwife in 7.4% of cases, by a physician specializing in 3.7% of cases.

・ Qualification of the health worker having done clinical exam

The patient had been examined by a doctor specializing in 54.1% of cases by a trainee interned in 43.5% of cases and by a midwife in 2.4% of cases.

・ Qualification of the health worker who made the diagnosis

The diagnosis was made by a physician specializing in 93.5% of cases, by a medical student in 5.1% of cases and by a midwife in 1% of cases.

・ Qualification of the health worker having given how to behave

The practical course of action was given by a doctor specializing in 98.2% of cases by a medical student in 0.9% of cases and by a midwife in 0.9% of cases.

・ Qualification of the health worker who administered the first aid

The treatment was administered to the patient by a physician specializing in 75.5% of cases by a medical student in 19.4% of cases and by a midwife in 5.1% of cases.

・ Delay factors

The distribution of the factors behind the management was presented in Table 2.

・ Proposals for patients and their escorts

The distribution of proposals and patients escorts to solve the problem of delay in care has been shown in Table 3.

The presence of investigators in the department may have influenced the behavior of the health workers. This is the source of possible bias that must be mentioned and taken into account in the interpretation of the results.

In our study, the delay in the care involved 216 patients that to say 8.2% of admissions. This result is comparable to Soma’s [9] who found a frequency of 8.7%. However, it is lower than Sanou’s [10] reported 49.4% in Ouagadougou. The differences between the series could be explained by the difference in the inclusion criteria. The high workload and low carrying capacity of the department may also explain the inability of practitioners.

In our study, the average waiting period between the arrival of the patient and the beginning of first aid was 142.7 ± 13.5 minutes (2 h 23 min) with extremes of 16 and 546 minutes (9 h 6 min). Our results are poor compared to those of Coutin [11] which reported an average waiting time of 18 minutes 37 minutes at obstetrics and gynecology. They are also poor, compared to those of Mbola [3] and Saizonou [12] which both reported an average delay of 30 minutes. The limited capacity of our emergency service, the limited number of operating room, the lack of staff of the guard team of operators and anesthetists could help to explain the situation.

In our study, the unavailability of the operating room was cited in 61.1% of cases, lack of examination tables in 24.1%, ignorance of the places in 14.8%, the lack of money in 15.7%, closing the pharmaceutical depot in 8.3% and incomplete kits in 8.8%. Our results are similar to those of Mayi-Tsonga [2] who also found that the main causes of delay in care were the unavailability of the operating room in 53% of cases, the occupation of the duty surgeon by another intervention in 53%, the absence of cloths and/or sterile instruments in 61% and the absence of anesthetics in 33% of cases.

Inadequate human resources and materials in developing countries are a veritable gangrene which hinders the fight against maternal mortality [5] . Also the poverty of our people and their illiteracies do not play in favor of the fight against maternal mortality. The government of Burkina Faso through the grant of obstetric and neonatal emergencies wanted to improve access to emergency care. But it is clear that difficulties persist and alienating those big efforts. The number of patients seeking gynecological and obstetric emergencies and poor infrastructure make it difficult to optimize emergency care. Urgent consultations are needed between practitioners and policy makers to reposition the subsidy policy.

・ Maternal morbidity

Maternal complications were noted in 13.4% of patients in our series. Our results are lower than Ido’s [13] who reported 28.1% in the same department, some years before. The difference between these figures could be explained by the perceptible positive impact of the grant. The workload of medical staff and the unavailability of the operating room are independent factors of the quality of care.

・ Maternal mortality

We recorded 0.1% of maternal deaths. This result is lower than Kaboré’s [14] who found a fatality rate of 3%. Despite the significant contribution of the grant, families continue to discuss financial difficulties and some support kits are incomplete. Also the low capacity of health facilities is a real obstacle to the success of achieving the Millennium Development. It is urgent to initiate reflection on completely free obstetric and neonatal emergencies like many countries in the sub region as Benin or Mali.

・ Fetal morbi-mortality

A birth death was noted in 13.8% of newborns whose causes were dominated by neonatal pain. Our results, although slightly better than those of kaboré [14] , are unacceptable for a country that aspires to emerge. Late administration of care in relation to the overload of medical personnel, unavailability of the operating room, the altered state of patients due to long distances to the reference center of the fetus are weakening factors born with a low Apgar score [15] . Also the distance from the neonatal unit compared to the obstetrics and gynecology department is not to the advantage of newborns; some dying for lack of adequate resuscitation.