Maternal Mortality in a Tertiary Care Center:a Five-year Review(Guinea).Sample of a Successful Management of an Obstetric Hemorrhage at Wuhan Union Hospi-Tal:a Case Report

[Objective] The main of our study was to assess the maternal mortality rate (MMR) in one tertiary hospital of Guinea, find out the relating causes and show that challenge which performed by Guinean government and health professionals reducing maternal death in the country.[Methods] A retrospective study of hospital records and death summaries of all maternal deaths over the period from January2008to December2012was carried out.[Results] Between2008and2012, there were a total of332maternal deaths out of44,035live births giving MMR of753.94per100,000live births. The records showed that90.97%maternal deaths were in women between20and44years. Near to half of the deaths occurred in unbooked women with late referral and highest of maternal deaths were reported in illiterate women (73%). Most maternal deaths were identified in multiparous, grand multiparous and great grand multiparous (25.60%,23.20%and23.49%respectively). After childbirth was identified as the time that most maternal deaths occurred, accounting for66.57%. The hemorrhage was the commonest cause of death (53.31%) followed by sepsis (18.38%) and eclampsia (15.06%).[Conclusion] This study provides information about maternal mortality in one Guinea’s largest tertiary hospital. Socio demographic factors, government employment for free maternal services, and training and recruitment of skilled specialized doctors and midwives are identified as strong contributors to Guinean’s progress towards reducing maternal mortality. [Implications for practice] Ensure adequate training and recruitment of skilled junior doctors and midwives; ensure training and information of traditional births attendants for early detection of birth complications and early referral. Provide well functioning equipped health-care facilities, and health education and information to the public to make good decision about their self well-being health improvement. The term of placenta percreta is used to describe any abnormal placental implantation in which the chorionic villi can reach not only the uterine serosa but also the adjacent organs. We reported an experience of successful conservative management of placenta percreta in the early second trimester of pregnancy. A31year-old patient presenting retained placenta following spontaneous abortion at17weeks of gestation was referred to our department from outlying hospital for continuous vaginal bleeding after failed long period of oral mifepristone administration. Ultrasound and magnetic resonance imaging proved their roles in the diagnosis and in the follow up. Our patient desired the conservative management; however, Methotrexate embolization of uterine artery arteries, uterine curettage within2weeks after Methotrexate embolization, surgical placenta removal with localized excision and uterine repair were chosen as skills. In our case, uterotonic agents showed a capital importance to prevent profuse hemorrhage. The follow up with serial serum β-Human chorionic gonadotropin testing was performed.