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[Role of abortion and ectopic pregnancies in maternal mortality rate at three university hospitals in Yaoundé].

INTRODUCTION
The World Health Organization (WHO) estimates that 585.000 women die every year in the world as a result of complications related to pregnancy, delivery, postpartum period and abortion (the latter contributing to 13% of maternal deaths). Ectopic pregnancies are responsible for 10% of maternal mortality in the first quarter of pregnancy. Maternal mortality rate is high in Cameroon, estimated at 782 per 100.000 live births according to EDS-MICS 2011. AS the role of these two conditions in maternal mortality is little documented in our country, we conducted this study to assess the role of abortions and ectopic pregnancies in maternal mortality rate in Cameroon.


METHODS
We conducted a retrospective and analytic study. We collected data from all the medical records of pregnant patients and pregnant patients died before the 28thweek of pregnancy at three university hospitals: Central Hospital of Yaoundé (HCY), Yaoundé Gynaecology, Obstetrics and Pediatrics Hospital (HGOPY), University Hospital (CHU), over a period of five years, from 1 June 2011 to 31 May 2016. Data were recorded on a pre-established and tested technical sheet, collected using CS Pro 6.2 software and analyzed using SPSS software 20. The statistical tests for comparison used were Khi 2 and Fischer test according to the effective sample. The threshold significance level was set at p <0.05.


RESULTS
We recorded 524 maternal deaths per 31116 live births, reflecting a maternal mortality rate (MMR) of 1538,9/100 000 live births. Out of 524 maternal deaths, 414 medical records were workable, including 100 (24.2%)abortions and 24 (5.8%) ectopic pregnancies. These 2 conditions contributed together to 30% of maternal deaths (124 medical records out of 414). The analysis of 124 medical records showed that the average age was 27.58 +/- 6 years, ranging from 18 to 48 years. The age group 20-24 years was the most represented (33.1%), followed by that 25-29 years (24.19%). The singles constituted 75%, housewives 36.7%, with level of secondary education in 62.5% and multigestes constituted 36.1% of our sample. 73.4% of patients didn't undergo any prenatal consultation and only 2.4% had undergone at least 4 consultations. Complications resulting in deaths were dominated by hemorrhage and infections.


CONCLUSION
Abortions and ectopic pregnancies are the major causes of maternal mortality in our country. We recommend strengthening of family planning to limit unwanted pregnancies and socio-economic support for patients at risk.