During the study period we recorded 1484 obstetric emergencies, of which 1101 were evacuees from the peripheral centers, a frequency of 74.2%.

Of these 1101 evacuees, 630 met our inclusion criteria, a frequency of 42.5%.

In 84.9% the socio-economic level was judged low (Table 1).

*The economic level was deemed low when the monthly income of the couple was below the minimum wage in Côte d’Ivoire (100 euros). And it was estimated average when income was less than 200 euros (less than the double of the minimum wage). **Prenatal follow-up was considered good when the recommended number of prenatal consultations (PCN) and prenatal check up (PCU) were actually performed. It was average when PCN or PCU were not completely done. And it was considered bad when no PCN and no PCU were done. 88% of the patients had mean prenatal follow up.

The average age was 25.93 years, with extremes of 14 years and 48 years. Patients under 20 years and over 34 years of age respectively represented 21% and 13.5% of the total.

62.7% of evacuees were not educated and 84.9% had low economic level.

Nulliparous and multiparous women accounted for 54.9% of the patients.

Urban health centers evacuated 75.2% of patients; the evacuees came from the city of Bouaké in 69.8% of the cases. Most of the evacuations were done by midwives (91.3%).

The evacuation form was badly filled in 49.70% of cases. No partograph was associated with the evacuation record for all evacuees (Table 2).

79.4% of patients did not receive care prior to evacuation.

The taxi was the most used means of transport (75.2%). It should be noted that no health worker accompanied the evacuees.

The average time spent in our series was 1 h 21 minutes with a minimum of 7 minutes and a maximum of 18.5 hours.

The evacuees took more than 1 hour to access the CHUB maternity in 38.6% of cases.

The evacuees who did not present any real motive of reference accounted for 38.6%; mechanical dystocia was used as a diagnosis in 26.3% of cases (Table 3).

In 43% of cases the diagnosis was not consistent with the motive for the evacuation.

69.4% of evacuees delivered vaginally.

84.8% of newborns had apgar scores ≥7 and 08.3% of newborns died (Table 4).

In 89.5% of cases the evolution was satisfactory.

We noted 17 maternal deaths in the evacuees out of 23 maternal deaths recorded in the service during the study period, including 52.9% by post-partum hemorrhage (Table 5).

In our study, the frequency of obstretic evacuation was 42.5%.

The frequencies vary from one study to another. This is due to the way patients are recruited, the criteria for inclusion, the importance of the center and its location area.

This high rate reported in our series could be explained by the fact that our hospital (study center) is the only reference university and hospital center located in province; It is in the second largest city of Cote d’Ivoire and covers a radius of about 200 km.

From the analysis of our results, the patients studied had many risk factors that could have been detected earlier to prevent certain complications.

The first factor identified is related to age. We have indeed noted a high rate of patient at the extreme ages of their fertility: 21% of adolescent girls and 13.5% of patients over 34 years. These are periods of high risk of complications in obstetrics. These situations are common in our regions because of socio-cultural habits. Indeed the area of Bouaké is a semi-urban area where early marriages are common in the rural part. Moreover, in these rural areas the notion of family planning is hardly accepted, explaining that women over 34 continue to have children. Several authors have found the same thing as us by reporting high rates of adolescent girls in their study [4] [5] [6] [7] [8] .

The second risk factor found was parity. The majority of our patients were either nulliparous (34.4%) or multiparous (20.5%), who are 2 groups exposed to obstetric complications.

The third risk factor identified was the poor socio-economic conditions of the majority of our patients: 84.9% of patients had a low economic level, rates copied to those reported by Traore D. [7] and Macalou B. [9] and Cisse [10] ; and 62.7% were not educated.

These patients were thus exposed to the ignorance and financial difficulties of management of the pregnancy.

The last risk factor identified was poor pregnancy monitoring. Indeed, no patient had a good prenatal follow-up.

Given these different risk factors, it is therefore important to provide a high-performance evacuation system to reduce maternal mortality as advocated by Adamson Peter [2]

-health worker responsible for the evacuation

In our series 91.3% of the patients were evacuated by midwives, compared to 6% by doctors; several authors found such high rates of evacuation by midwives [4] [7] [8] [11] . On the other hand, Berthe D [12] in Mali noted in his study 34.4% evacuations made by doctors compared to 24.8% by midwives.

The high rate of evacuation performed by midwives testifies the fact that among medical staff they are the most numerous in the obstetrical health structures in Cote d’Ivoire (1 midwife for 2000 inhabitants compared to 1 doctor for 9000 inhabitants).

The retraining, upgrading and awareness of some midwives could help prevent abusive evacuations and delays in evacuation.

-Means of transport

74.6% of the patients were evacuated by taxi in our work; Sépou [11] reported a rate of 68.6% whereas the ambulance was the most used means of evacuation in the series of Thiam [5] , Thera [13] , Guindo [14] .

The disadvantage of the transfer made in non-medical conditions is the aggravation of the health conditions of the patients.

It is therefore necessary that interventions aiming at improving the transport of women with complications be divided into two categories: those aiming at improving the transport of women from their community to the health center and those aiming at improving transport between two health centers of different levels [15] .

-The Admission delay

The average time taken by patients to access the reference center in our series was 1 h 21 minutes

The high admission time was due to road conditions, lack of vehicle and distance. It was also due to the lack of financial means, the non-acceptance of “the eventual cesarean section”. These reasons sent the parents home before going to the referral center.

The lack of medical transport and the high admission delay help to delay the referral of patients and this contributes to aggravate the fetomaternal prognosis

In 43% of the cases the diagnosis was not consistent and 38.6% of the evacuees had not presented a real reason for referral;

This evacuation would be triggered by a superficial diagnosis related to the quality of the health worker and / or the quality of the technical platform; The delivery could have been done in the first contact health center and avoid the cost of additional transportation.

Thera [13] noted in his study that 92.2% of references were adequate, 78.3% justified and 72.2% appropriate.

During the study period, we recorded 23 cases of maternal deaths including 17 discharged patients (74%) meeting our inclusion criteria; results comparable to those reported by Cisse ML: [10] and Tshalu-Aguemon [16] .

These patients arrived in our service in very precarious states due to the lack of adequate care before their transfer, the lack of adequate means of evacuation, the admission time delayed. Obstetric evacuation remains a negative factor in the maternal-fetal prognosis in our regions and makes access to effective care one of the solutions to the drama of maternal mortality.