Accouchement chez la primipare à Lubumbashi: pronostic maternel et périnatal

INTRODUCTION: Childbirth in primiparous women is associated with many complications and, therefore, primiparous women are considered high risk due to maternal and fetal concerns. This study aims to determine birth rate in primiparous women in our environment, to identify factors associated with delivery by cesarean section and to assess maternal and perinatal morbi-mortality from childbirth in primiparous women living in Lubumbashi. METHODS: We conducted a cross-sectional, analytical study of singleton births in 10 referral maternity hospitals in Lubumbashi over the period December 2013-May 2014. Primiparous births were compared to multiparous births. Maternal sociodemographic parameters as well as maternal and perinatal morbi-mortality were analyzed. The odds ratio and its confidence interval were calculated. Threshold significance level was set at p < 0.05. RESULTS: Primiparity rate was 19.9%. Compared to multiparous births, primiparous births were mainly observed in adolescents (OR=11. 27, (7.98-15.91)), in students (OR = 5.61 (3.33-9.45)) and in women living alone (OR=7.62 (4.36-13.30)). Risk factors associated with delivery by cesarean section in primiparous women included obstetric evacuation (OR = 9.69 (4.75-19.74)), the lack of prenatal monitoring (OR=2.57, (1.32-5.01)), size ≤ 150 cm (OR = 2.42 (1.04-5.65)), uterine height > 34 cm (OR = 2.33 (1.32-4.10)) and malpresentation (OR = 6.37 (2.92-13.87)). With regard to maternal prognosis, we observed that high blood pressure (OR = 1.91 (1.32-2.74)), malpresentation (OR = 1.95 (1.16-3.17)), oxytocin use (OR = 2.03 (1.64-2.52)), cesarean section (OR = 2.04 (1.47-2.83)), episiotomy (OR=11.89 (8.61-16.43)) and eclampsia (OR = 4.21 (1.55-11.44)) were significantly associated with primiparity. The rates of low 5th minute Apgar score (OR = 1.55 (1.03-2.32)) and of deaths occurred during early neonatal period (OR=1.80 (1.08-2.98)) were significantly higher in primiparous women than in multiparous women. CONCLUSION: This study shows that primiparous birth is a problem in Lubumbashi. Hence improvement in mother-child care during primiparous childbirth includes the development of protocols for adequate management of childbirths.