Mayi-Tsonga Sosthène, Meyé Jean-François, Tagne Alain, Ndombi Isabelle, Diallo Thierno, Oksana Litovchenko, Mendome Gabriel, Mounanga Mathieu
Maternité du Centre hospitalier de Libreville, Centre hospitalier de Libreville, BP 2758, Libreville, Gabon.
Sante. 2007 Apr-Jun;17(2):111-5.
To examine "near-miss" cases to identify the weak points of our department.
This prospective study took place at the Libreville Hospital Maternity Center for six months, from 1 June to 31 December 2006. It included all pregnant women with a severe obstetrical complication (uterine haemorrhage with signs of shock, eclampsia, severe infection) or whose condition required a major intervention to prevent death. The quality of these patients' management was studied from their arrival in the department to their discharge.
The prevalence of near-misses was of 3.15%, that is, 137 cases among 4350 deliveries. Ruptured ectopic pregnancies, haemorrhage following clandestine elective abortions, and post-partum haemorrhages (third stage of delivery) were the three primary causes for near misses. Almost 40% of these women waited more than 45 minutes before seeing any qualified personnel. Once the patient was seen, clinical examinations were impossible for 22% because of the lack of the appropriate material. The average time to surgery was 5 hours and 15 minutes. The lack of sterilized surgical linens was one of the major causes of delay in surgical management.
The number of patients seeking care in our department, relative to the staff resources, makes it difficult to optimise the quality of emergency obstetric care.
检查“险些发生的失误”病例，以确定本部门的薄弱环节。
这项前瞻性研究于2006年6月1日至12月31日在利伯维尔医院产科中心进行了6个月。研究对象包括所有患有严重产科并发症（伴有休克体征的子宫出血、子痫、严重感染）或其病情需要进行重大干预以预防死亡的孕妇。从这些患者入院到出院，对其治疗质量进行了研究。
险些发生失误的发生率为3.15%，即在4350例分娩中有137例。异位妊娠破裂、秘密选择性堕胎后出血以及产后出血（分娩第三阶段）是险些发生失误的三个主要原因。这些女性中近40%在见到任何合格人员之前等待了超过45分钟。一旦见到患者，由于缺乏合适的材料，22%的患者无法进行临床检查。手术平均时间为5小时15分钟。缺乏消毒手术床单是手术治疗延迟的主要原因之一。
相对于工作人员资源，到本部门寻求治疗的患者数量使得优化急诊产科护理质量变得困难。
