Perinatal morbidity and mortality and the impact of neonatal resuscitation day-by-day calamity evidenced by a prospective descriptive study in Guinea-Conakry

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Abstract Background Perinatal mortality represents a major health care problem in particular in low and middle-income countries, which account for 97% of all late fetal and 98% of all neonatal deaths. Our objectif was to analyse perinatal morbidity and mortality at the largest maternity clinic of Guinea, in sub-Saharan Africa. Patients & Methods: Prospective observational evaluation of the perinatal morbidity and mortality between May 1st and June 30th 2019 at the Clinic of Obstetrics of the University Hospital Ignace Deen in Conakry, Guinea. Results Of the 1189 deliveries, 98 (82‰) fetus were born dead, 58.1% of them with signs of maceration. 14.1% of all infants had low birth weight (< 2500 g) and 10.6% were macrosome (> 4000 g). The rate of preterm infants was 9.3% and 99 infants (8.3%) showed signs of post-maturity. At birth, 6.8% of all live born infants had asphyxia, 10.9% respiratory distress, 1.9% infection, 0.3% malformation, and nine infants died within the first postnatal minutes. Need for any resuscitation manoeuvres showed 304 infants (27.9%), 68.8% of them needed bag and mask ventilation and 27.0% chest compressions. Infants with bad Apgar score at 1 and 5 minutes did improve by 10 minutes thanks to respiratory support, but not due to chest compression. As there is no neonatal unit in the same hospital, 192 infants (17.6%) had to be transferred across Conakry to the only tertiary neonatal unit. Due to lack of any (para-)medical transport system for newborn infants, mortality of these neonates is very high and adds to the total perinatal mortality of 143.8 deaths/1000 deliveries. Conclusions Late pregnancy control is very poor in Conakry, leading to delayed referral of high-risk pregnancies to the university hospital. This goes along with high rates of stillbirths, post-term and macrosome infants with increased risk for delivery complications like postnatal adaptation problems and asphyxia. Resuscitation algorithm needs to be adapted to the local context. A hospital-based neonatal unit for primary stabilization and a medicalised neonatal transport system within Conakry needs to be implemented to decrease the high mortality rate.

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