Anestesia obstétrica en Chad. Volviendo a los orígenes

Abstract

Background: Most maternal deaths occur in low-and middle-income countries, with Chad being one of the countries with the most alarming figures. There aren't many reports of anesthetic management for cesarean delivery in these countries. Aim: To report the obstetrical anesthetic experience in a hospital in Chad, Africa in the context of an international cooperation project to reduce the global shortage of anesthesiologists. Material and Methods: Case series of pregnant woman who were admitted to the ward of the Good Samaritan University Hospital Complex. Results: Thirty-two cesarean sections were performed, all using spinal anesthesia. The median age was 22 years, seven of them being adolescents. In two cases sedation with ketamine was used due to insufficient level and in one case general anesthesia with halothane was converted due to total spinal diagnosis. In twelve patients the interruption was due to immediate maternal/fetal vital risk (emergency cesarean section), the main causes being fetal bradycardia and placental abruption. Three patients presented uterine inertia refractory to medical treatment and resolved with the B-Lynch technique. Two patients decided to have immediate skin-to-skin contact. Three neonates had to be resuscitated with positive pressure ventilation, one of them died. No operative deaths were reported in the patients who underwent c-section, but there was one maternal death due to severe preeclampsia and postpartum hemorrhage after vaginal delivery. No epidural analgesia was requested for labor. Conclusions: This individual report provides insight into a particular reality with very limited staff and resources.