In 2006, a national strategy to subsidize birth deliveries and emergency obstetrical and neonatal care (SONU) has been adopted in Burkina Faso. This strategy aims at improving the access of the populations to emergency obstetrical operations. Such measures have brought about a significant increase in the number of operations in gynecology obstetrics. However, according to several authors, the increase of surgical operations seems to be related to an acute higher morbidity and mortality risk  ; the increase of caesarean sections is also related to a rise of the fetal mortality and the number of newborns admitted in neonatology unit   . Surgical procedures in gynecology and obstetrics are dominated by caesarean section, hysterectomy and myomectomy, according to many authors   . If in developed countries gynecological surgery is mainly performed by laparoscopic surgery, in most African countries laparotomy is still widely used   . Locoregional anesthesia is most often used   . This is why we have decided to undertake an analysis of surgical operations performed in the gynecology and obstetrics department of the CHU-Yalgado Ouédraogo.
2. Patients and Methods
This dealt with a cross-cutting descriptive and analytic study with a retrospective data collection over the period January 1st, 2015 to December 31st, 2015. Such study was implemented in the gynecology and obstetrics department of the CHU Yalgado Ouédraogo in Ouagadougou (Burkina Faso). We have included in our study all the female patients who underwent surgical operation in the operating room and whose medical file was complete. Data were collected through a form developed in this purpose. Sociodemographic characteristics, the operating indications, the type of anesthesia, the prognosis were the items. Data sources included clinical records of the operated patients, the records of the operatory and anesthetic reports and admission records. This research was approved by the patient themselves.
Data were entered through the software Cspro 5.0 and analyzed through the software SPSS 20. The overall statistical tests of our analysis were considered significant for a threshold p < 0.05.
In 2015, the gynecology-obstetrics department has recorded 9198 admissions among which 4134 underwent surgical operations, which corresponds to 45%. We have found 3161 usable records of operated patients.
3.2. Sociodemographic Characteristics of Female Patients
The average age was estimated at 28.02 years ± 7 years with extremes of 13 and 80 years. Housewives accounted for 54% of patients, followed by salaried women representing 12%. Female patients were living in union in 92% of cases. The nulliparous patients represented 38.7% of cases and the primiparous ones 22%.
3.3. Surgical Operations Performed
Obstetrical surgery has been carried out in 89.9% of cases. Female patients have received a loco-regional anesthetic in 92.7% of cases. Emergency surgical operations accounted for 88.8% of cases against 11.2% for the scheduled surgical operations.
The surgical operations carried out are presented in Table 1.
Caesarean section and salpingectomy for ectopic pregnancy were the most performed surgical operations with respectively 87.1% and 3.7% of cases.
3.4. Prognosis of the Patients Operated
Thirty-six (36) female patients, which correspond to 1.1%, have had some per operative complications. Such complications mainly included hemorrhage (18 cases) and some deaths (9 cases).
We have observed post-operative complications on 231 female patients. Such complications mainly included anemia, parietal suppuration, endometritis and thromboembolic complications with respectively 66 cases, 22 cases, 11 cases and 09 cases. Table 2 presents the factors we have found and which are related to post-operative complications.
The occurrence of post-operative complications is related to contributing factors such as emergency surgery, general anesthesia, neonatal death, distance
Table 1. Surgical operations conducted.
Table 2. Factors associated with the occurrence of post-operative complications.
traveled before reaching the CHU-YO, the unmarried status and the housewife status as an occupation.
3.5. Mortality among the Operated Female Patients
We have recorded 33 cases of death out of the 3161 surgical operations collected, corresponding to a global mortality rate of 1.04%. The totality of these deaths has occurred among the female patients who underwent emergency surgery, corresponding to an emergency mortality rate of 1.2%. Mortality rate is higher among the urgently operated patients with a significant difference according to Fisher test (p = 0.019). The mortality rate following the surgical operation performed is indicated in Table 3.
Hysterectomy for uterine rupture and valve examination for hemorrhage during the delivery period were most mortal.
・ Limitations of study: Due to retrospective collect of data, we notice the following limitations: the miss data for some of variables. As well, our cases were selected in the folders based on which the medical file was complete. It is obvious some medical file were miss, then an under-estimation of frequency.
・ The average age of our study was estimated at 28.02 years. Our result is the same with that of Nayama  in Niamey who found 27.22 years. It is above that of Akotionga  in Ouagadougou who found 25.6 years; this is due to the fact that Akotionga’ study only focused on emergencies generally occurring among the young patients.
・ In our series, the nulliparous women were the most represented patients with 39% of cases. The predominance of nulliparous women can be explained by the fact that they present more complications requiring a surgical operation compared to multipara women , as highlighted by several authors     .
・ A total of 2752 caesarean sections were performed corresponding to 87.1% of the overall surgical operations conducted in the department. Our result was close to that of Traoré  in Mali who found 91%. It is below that of Nayama  , who has found 81.35%. Our result can be explained by the fact that
Table 3. Mortality rate as per surgical operation.
NB: UR: uterine rupture.
caesarean section is subsidized since 2006 as part of SONU program and the opening of a specialization cycle in gynecology and obstetrics.
・ In our series, the per operative complications have occurred among 36 female patients corresponding to 1.14%. The main per operative complications encountered were hemorrhage, deaths and lesions of the urinary tract. Lamboudié  in France has mentioned that the most common per operative complications from hysterectomies were hemorrhagic complications. Ze Minkandé  in Yaoundé et Nzau in Kinshasa  also found that hemorrhages were predominant. This predominance of hemorrhages can be explained by the fact that most surgical operations are performed in emergency situation without pre anesthesia consultation and without any assessment of the coagulation.
・ The proportion of post-operative complications in our series was estimated at 7.3%. Our rate is higher than that of Bambara et al. In Bobo  who found 4.6% and is below those of Ouédraogo et al. in Ouagadougou  and Andriamady et al. in Madagascar  who respectively found 18.8% and 29.5%. Our result could be explained by an improvement in the surgical treatment of patients admitted in gynecology and obstetrics department.
・ The mortality rate in our series was estimated at 1.04% and is below that of Buambo in Brazzaville reaching 3.6%  . In our series, the hysterectomies for uterine ruptures and valve examinations for cervico-vaginal soft tissues tears were the most mortal surgical operations. Such surgical operations occur in a context of significant hemorrhage. Several authors have highlighted the predominance of hemorrhages in death causes. Therefore, Maina et al.  in Kenya have found that half of the death cases were related to hemorrhages. Rafanomezantsoa et al.  in Madagascar have made the same observation.
This study shows that surgical activities within gynecology and obstetrics department of the CHU-Yalgado Ouédraogo are mainly dominated by obstetrical surgery represented by caesarean. Mortality rate was estimated at 1.04% and hemorrhage was the main cause of death. A better availability of labile blood products will enable to reduce this mortality rate of surgical operations under the threshold of 1%.
 Villar, J., Valladares, E., Wojdyla, D., Zavaleta, N. and Carroli, G., for the WHO 2005 Global Survey on Maternal and Perinatal Health Research Group (2006) Caesarean Delivery Rates and Pregnancy Outcomes: The 2005 WHO Global Survey on Maternal and Perinatal Health in Latin America. The Lancet, 367, 1819-1829.
 Abalos, E. (2009) Variante technique et matériel pour la césarienne: Commentaire de la BSG (dernière mise à jour: 1er mai 2009). Bibliothèque de Santé Génésique de l’OMS; Genève, Organisation mondiale de la Santé. [In English: Abalos, E. (2009) Technical Variation and Material for Caesarean Section: Comments of BSG (Last Update: May 1st 2009). WHO’s Library Genesis, Geneva, World Health Organization]
 Nayama, M., Garba, R.M., Idi, N., Annaboabdou, I., Sahabi, S., Oumara, M., et coll. (2013) Prise en charge de la GEU à la MIG: A propos de 130 cas. Communication XIIème Congrès de la SAGO/IVème Congrès de la SGON Niamey 2013. [In English: Nayama, M., Garba, R.M., Idi, N., Annaboabdou, I., Sahabi, S., Oumara, M., et al. (2013) Treatment of GEU to MIG: 130 Cases Studied. Communication XII Congress of SAGO/IV Congress of SGON Niamey 2013]
 Akotionga, M., Sawadogo, Y., Lankoande, J. and Kone, B. (1999) Morbidité and mortalité maternelles postopératoires en milieu africain. A propos de 583 cas de GEU, de césariennes et de rupture utérines au CHU-YO. Revue Francaise de Gynécologie et d’Obstétrique, 94, 460-466. [In English: Akotionga, M., Sawadogo, Y., Lankoande, J. and Kone, B. (1999) Post-Operative Maternal Morbidity and Mortality in African Context; 583 Cases of GEU, of Caesarean Sections and Uterine Rupture Studied in CHU-YO. French Revue of Gynecology and Obstetrics, 94, 460-466]
 Bambara, M., Fongan, E., Dao, B., Ouattara, S., Ouattara, H., Lankoandé, J., et coll. (2007) La césarienne en milieu africain: à propos de 440 cas colligés à la maternité du CHU Sourou Sanon de Bobo-Dioulasso (Burkina Faso). Médecine d’Afrique Noire, 54, 343-348. [In English: Bambara, M., Fongan, E., Dao, B., Ouattara, S., Ouattara, H., Lankoandé, J., et al. (2007) Caesarean Section in African Context: 440 Cases Collected at the Maternity of the Teaching Hospital Soro Sanou of Bobo-Dioulasso (Burkina Faso)].
 Nkwabong, E., Kouam, L., Wamba, T., Ngassa, P., Doh, As., Mve, K.V., et coll. (2006) Indication des césariennes à la maternité du CHU de Yaoundé de 2000 à 2004. Clinics in Mother and Child Health, 3, 453-455. [In English: Nkwabong, E., Kouam, L., Wamba, T., Ngassa, P., Doh, As., Mve, K.V., et al. (2006) Caesarean Section Indication at the Maternity OF Yaoundé CHU from 2000 to 2004. Clinics in Mother and Child Health, 3, 453-455]
 Ouédraogo, C., Zoungrana, T., Dao, B., Dujardin, B. et Koné, B. (2001) La césarienne de Qualité au Centre Hospitalier Yalgado OUEDRAOGO de Ouagadougou. Analyse des déterminants à propos de 478 cas colligés dans le service de Gynécologie obstétrique. Médecine d’Afrique Noire, 48, 443-51. [In English: Ouédraogo, C., Zoungrana, T., Dao, B., Dujardin, B. and Koné, B. (2001) Quality Caesarean Section in the Teaching Hospital Yalgado OUEDRAOGO of Ouagadougou. Analysis of Determinants on 478 Cases Collected in Gynecology and Obstetrics Department]
 Solofomalala, G.D., Randriamalalaarijoana, R.T., Rasendramino II, M., Ratsivalaka, R. and Canonne, F. (2007) Les urgences gynéco-obstétricales dans une maternité de district Malgache. Revue Tropicale de Chirurgie, 1, 67-70. [In English: Solofomalala, G.D., Randriamalalaarijoana, R.T., Rasendramino II, M., Ratsivalaka, R. and Canonne, F. (2007) Gyneco-Obstetrical Emergencies in a Maternity of Madagascar District. Surgery Tropical Review, 1, 67-70]
 Traore, B., Kokaina, C., Beye, S.A., Traore, M. and Dolo, A. (2010) Césarienne au Centre Hospitalier Régional de Ségou au Mali. Médecine d’Afrique Noire, 57, 513-518. [In English: Traore, B., Kokaina, C., Beye, S.A., Traore, M., Dolo, A. (2010) Caesarean section in the Regional Hospital Center of Ségou in Mali].
 Nayama, M., Bembello-Trapsida, L., Garba, M., Idi, N. and Babana, Aa. Opérations césariennes à la maternité ISSAKA GASOBI (MIG) de Niamey à propos de 788 cas en 4 mois (du 1 janvier au 30 avril 2009). Communication XIIème Congrès de la SAGO/IV ème de la SGON: Niamey, 2013. [In English: Nayama, M., Bembello-Trapsida, L., Garba, M., Idi, N. and Babana, Aa. Caesarean Sections at the Maternity ISSAKA GASOBI (MIG) of Niamey: 788 Cases Studied in 4 Months (From January, 1st to April, 30th 2009). Communication XII Congress of SAGO/IV Congress of SGON: Niamey 2013]
 Lambaudie, E., Boukerrou, M., Cosson, D., Querleu, G. and Crépin, G. (2000) Hystérectomie pour lésions bénignes: Complications per opératoires et postopératoires précoces à l’hopital Jeanne de Flande, CHRU de Lille. Annales de Chirurgie, 125, 340-345. [In English: Lambaudie, E., Boukerrou, M., Cosson, D., Querleu, G. and Crépin, G. (2000) Hysterectomy for Mild Lesions: Early per Operative and Post-Operative Complications at the Hospital Jeanne de Flande, CHRU of Lille. Annales de Chirurgie, 125, 340-345]
 Zé Minkande, J., Mboudou, E., Afane Ela, A., Metogo Mbengono, J.A., Binam, F., Nko, O., et coll. (2012) Impact de la check-list dans la survenue des complications per et postopératoires en chirurgie gynécologique et obstétricale, communication au 28ème congrès de la SARANF, Abidjan. 15. [In English: Zé Minkande, J., Mboudou, E., Afane Ela, A., Metogo Mbengono, J.A., Binam, F., Nko, O., et al. (2012) Check-List Impact in the Occurrence of per Operative and Post-Operative Complications in Gynecological and Obstetrical Surgery, Communication during the 28th Congress of SARANF, Abidjan. 15]
 Nzau, N., Mboloko, E., Tandu-Umba, N.F.B. and Lokengo, L.D. (2012) Hystérectomie aux Cliniques Universitaires de Kinshasa: De 2002 à 2010. Médecine d’Afrique Noire, 59, 222-2030. [In English: Nzau, N., Mboloko, E., Tandu-Umba, N.F.B. and Lokengo, L.D. (2012) Hysterectomy in the University Clinics of Kinshasa: From 2002 to 2010. Médecine d’Afrique Noire, 59].
 Andriamady, C.L., Rasoarimahandry, M.O., Andrianarivony, R. and Ranjalahy, J. (2001) Indications and Prognosis of Cesarian Sections at Befelatanana Women’s Hospital UHC of Antananarivo (529 Cases, during the Year 1998). Gynecology Obstetrics & Fertility, 29, 900-904.
 Buambo-Bamanga, S.F., Oyere-Moke, P., Babiessa, F., Gnekoumou, L.A., Nkihouabonga, G. and Ekoundzola, J.R. (2010) La grossesse extra-utérine (GEU): étude de 139 cas colligés au Centre Hospitalier et Universitaire de Brazzaville. Médecine d’Afrique Noire, 57, 260-264. [In English: Buambo-Bamanga, S.F., Oyere-Moke, P., Babiessa, F., Gnekoumou, L.A., Nkihouabonga, G. and Ekoundzola, J.R. (2010) Ectopic Pregnancy (EP): Study on 139 Cases Collected at the Teaching Hospital of Brazzaville. Médecine d’Afrique Noire]
 Rafanomezantsoa, T.A., Harioly Nirina, M.O.J., Fenomanama, S., Ramarokoto, M.P.M., Andrianampanalinarivo, H.R. and Raveloson, N.E. (2014) Mortalités maternelles vues à l’hopital universitaire de gynécologie obstétrique de Befelatanana: 2011-2013. Médecine d’Afrique Noire, 61, 623-628. [In English: Rafanomezantsoa, T.A., Harioly Nirina, M.O.J., Fenomanama, S., Ramarokoto, M.P.M., Andrianampanalinarivo, H.R. and Raveloson, N.E. (2014) Maternal Mortalities Reviewed at the Teaching Hospital of Gynecology Obstetrics of Befelatanana: 2011-2013. Méd Afr Noire, 61, 623-628]