Prehospital Emergency Obstetric Care by SAMU in Kigali, Rwanda

Author(s): Rosenberg A, Nyinawankusi J, Habihirwe R, Dworkin M, Nsengimana V, Putman J, Kankindi E, Niyonsaba M, Ritter A, Ntirushwa D, Ndikuryayo E, Uwitonze, JM, Kabagema I, Dushime T, Jayaraman S

Background: In Rwanda, 52% of the population is female and 25% of the population is of childbearing age. We sought to understand the care provided for obstetric and gynecologic emergencies in the prehospital setting in Rwanda.

Methods: Descriptive analysis was performed of demographic, indication, and intervention data for obstetric emergencies between December 2012 to May 2016 collected in a prospective database.

Results: Nearly 16% of 11,161 patients seen by SAMU were for obstetric emergencies. The average age was 26 (+ 9). Delivery-related included labor (76%) and retained placenta (10%). Pre-delivery complications, such as threatened abortion (26%) and miscarriages (24.5%), were 19% of all obstetric cases and 3.5% of cases were postpartum problems such as postpartum hemorrhage (59%) and infection (31%). Of 826 women in labor, the average dilation was 5.8 + 3.1 cm. SAMU staff delivered 317 healthy babies in the prehospital setting.

Conclusion: Obstetric emergencies need early recognition and intervention to support optimal outcomes for both mother and child. In Kigali, Rwanda, SAMU provides needed emergency obstetric care in the prehospital setting. Supporting their training on management of obstetric emergencies is likely to have substantial impact on maternal and fetal outcomes in the country.

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