Ketamine pour la gestion de la douleur post hystérectomie au CHU Professeur Zafisaona Gabriel Mahajanga Madagascar / Ketamine for the management of post-hysterectomy pain at the Professor Zafisaona Gabriel University Hospital, Mahajanga, Madagascar

Une analgésie multimodale est incontournable pour la prise en charge de la douleur post opératoire. L'objectif de notre étude était de montrer l'intérêt de l'utilisation de la kétamine, avec son effet analgésique, parmi les différentes molécules disponibles. Méthodes : Il s'agit d'une étude prospective monocentrique en simple aveugle de 31 cas d'hystérectomie programmée sur une période de 6 mois (mai­octobre 2016) divisée en deux groupes soumis au même protocole anesthésique : un groupe recevant de la kétamine en bolus suivi d'une perfusion continue peropératoire et sur les premières 24 heures et un groupe contrôle sans kétamine. En période post opératoire les deux groupes bénéficient d'une analgésie multimodale. L'analyse statistique a été faite par le test de Student. Résultats : Les scores de douleur diffèrent peu en moyenne sur les 24 heures de surveillance, tandis qu'une épargne morphinique importante est notée dans le groupe kétamine de l'ordre de 50% avec une valeur de p<0,001 fortement significative. A côté nous n'avons constaté aucun effet indésirable notable. Conclusion : L'adjonction de kétamine même de brève durée dans la prise en charge de la douleur post opératoire a permis de baisser considérablement la consommation morphinique

Preferred and actual methods of hysterectomy: a survey of current practices among members of the South African Society of Obstetricians and Gynaecologists

Background. Hysterectomy remains one of the most common operative procedures for benign uterine diseases. Total abdominal hysterectomy (TAH) constitutes the most common approach despite the advantages of minimally invasive hysterectomy (MIH). Objectives. To explore the current opinion on hysterectomy choices amongst members of the South African Society of Obstetricians and Gynaecologists (SASOG), as well as the perceptions and potential barriers that may inhibit gynaecologists from offering MIH to their patients. Methodology. An anonymous survey designed to explore the preferences of practising obstetrician gynaecologists regarding the optimal hysterectomy procedure, and perceived barriers towards MIH. Results. The average age of the respondents (N=152) was 45.7 years, with 88.2% having >5 years' experience in private practice. When asked about the preferred route of hysterectomy for themselves or their relatives, 46.2% chose vaginal hysterectomy (VH), 25.4% chose total laparoscopic hysterectomy (TLH), 15% chose laparoscopic assisted vaginal hysterectomy (LAVH) and 8.5% chose TAH. However, the most commonly performed hysterectomy procedure undertaken by the respondents in the last year was TAH. Only half of the respondents wished to increase their rate of VH and a lesser number to extend their laparoscopic hysterectomy rates. Conclusion. Although the majority of the respondents preferred the minimally-invasive VH or TLH for themselves or their relatives, TAH remains the most common hysterectomy method among SA gynaecologists. This difference could present an ethical dilemma for the gynaecologist. The desire of a minority to change their approach to VH indicates the difficulty in changing attitudes and the need to promote VH as a technique within SASOG

A seven-year review of emergency obstetric hysterectomy in a Nigerian tertiary institution

Background:Extirpativeuterinesurgeries for near-miss events are usually thelast resort when other conservative measures fail.Emergency obstetric hysterectomy(EOH)may still have a significant role where there are limited options.Objectives:To determine the prevalenceof EOH, theassociatedfactorsandthe foeto-maternal outcomeat the Olabisi Onabanjo University Teaching Hospital, Nigeria.Methods:This was a retrospective observational study covering sevenyears (January 2010 to December 2016). The case records of patients who hadEOH during this period were retrieved for data extraction. Results:There were 5,608 deliveries and 31 cases requiringEOH giving aprevalence rateof31/5,608(0.55%). The mean age of the patients was 30.3±4.2years, whilethe mean gestational age at delivery was 36.3±5.1 weeks. Most of thepatients16/25(64.0%) were of higher parity (>3), and12/25(48%)of the patients were within the age bracket of 25-34 years. Subtotal hysterectomywas the most common procedure(18; 72.0%), andruptured uterus wasthe main indication for EOH (40.0%). The twomost common interventions that were critical to survival includedmassive blood transfusion (24.0%)andIntensive Care Unit admission (20%).Two (8%)maternal deathsand 58.3% perinatal mortality wererecorded.Conclusion:EOH is still relatively frequently performedat this centredue tothehigh incidence of a ruptured uterus. Effortsshould be made to increase the proportion of deliveries attended by skilled personnel and improvethe capacity of lower levelhospitals for comprehensive emergency obstetric care

Evaluation of protocol of management of morbidly adherent placenta in maternity Zagazig university hospital

Background: Morbidly adherent placenta (MAP) defines the abnormal adherence of the placenta to the underlying uterine wall. It has a rising incidence world-wide. The risk of placental abnormalities increases in the presence of uterine scars due to cesarean delivery or gynecologic procedures. It may lead to massive obstetric hemorrhage resulting in serious complications such as DIC, transfusion related complications. Aim: Evaluation of protocol of management of patients with morbidly adherent placenta at Maternity Zagazig University Hospital and its effect on pregnancy outcome to find the best method of management to decrease associated morbidity and mortality.Patients and methods: This cohort study conducted on 120 patients diagnosed as having morbidly adherent placenta and were admitted to Zagazig University Hospitals.Results: In our study there were 48 cases (40%) managed by CS only and 72 cases (60%) managed by hysterectomy.Conclusion: well-planned caesarean hysterectomy with placenta left in situ adopting multidisciplinary approach is the recommended management option for MAP

Intégration de la colposcopie comme méthode de dépistage des lésions précancéreuses et cancéreuses dans le paquet minimum d'activités dans une maternité niveau 3 sur une série de 569 cas. Exemple du CHU de Yopougon - Abidjan

Contexte : Les techniques de dépistage des lésions précancéreuses les plus efficaces et rentables dans les pays africains comprennent les inspections visuelles à l'aide de tests d'acide acétique et lugol tels que recommandés par l'OMS car peu coûteuses, indolores, simples à réaliser, reproductibles, socialement et culturellement acceptables, sans effets secondaires avec des résultats immédiats.Objectifs : Déterminer le taux de participation des femmes et ses déterminants, la prévalence des lésions précancéreuses et leur prise en charge. Patientes et méthodes : De janvier 2011 à décembre 2013, 569 femmes volontaires âgées de 18 à 65 ans, ayant eu une activité sexuelle ou non, porteuse ou non d'une grossesse de moins de 15 semaines d'aménorrhée, après un passage en consultation ou aux urgences pendant lesquelles, un dépistage par la méthode visuelle a été proposé ont été incluses. La colposcopie a eu lieu au service de Gynécologie-Obstétrique du Centre Hospitalier Universitaire de Yopougon Abidjan. Les prélèvements biopsiques étaient acheminés au laboratoire d'anatomie pathologie du Centre Hospitalier Universitaire de Treichville Abidjan. Les données ont été recueillies et analysées en utilisant le logiciel Epi info version 3.4.5.Résultats : Le taux de participation des femmes était en général de 6,03%. L'âge moyen de la population était de 40,3 ans IC1-α [36,2-44,4]. La moitié de la population (52,4%) n'avait pas de revenus fixes, et 36,9% d'entre elles étaient non-instruites. 74,2% des femmes habitaient la commune et étaient situées dans un rayon de 10 km. 20,2% des patientes étaient ménopausées. Les lésions acidophiles et iodo-négatives étaient respectivement de 8 et 10%. La prévalence des lésions précancéreuses et cancéreuses à la colposcopie était de 9,3% des cas. Les néoplasies intra épithéliales (CIN) CIN 1 représentaient près de la moitié des cas prélevés (44,8%) quand les CIN 2 et + totalisaient 20,7%. Soixante-huit virgule neuf pour cent (68,9%) des transformations atypiques (TAG) avaient des néoplasies intra-épithéliales de tout grade confirmées histologiquement. L'hystérectomie simple et l'électro-conisation ont été effectué respectivement chez 5,7 et 11,3% des femmes toutes CIN 2 et +. La cryothérapie avait été faite chez les femmes jeunes avec une CIN 1 soit 24,5%. Conclusion : Intégrée dans le paquet minimum des activités des centres hospitaliers, la colposcopie pourrait contribuer à la réduction de l'incidence et la mortalité liée au cancer du col de l'utérus dans nos pays

Emergency Obstetric Hysterectomy in a Tertiary Hospital in Sokoto; Nigeria

Emergency obstetric hysterectomy (EOH) is a life-saving procedure which is often performed to treat some obstetric complications; as a last resort; to prevent maternal mortality. Objectives: This study was designed to determine the rate; indications; and complications of the EOH procedure at Usmanu Danfodito University Teaching Hospital (UDUTH); Sokoto. Materials and Methods: This retrospective study involved all the patients who had EOH at UDUTH; Sokoto; Nigeria; between January 2005 and December 2010. The case records of these patients were retrieved from the medical record library and information relating to age; parity; booking status; indications; type of hysterectomy; cadre of the surgeon; type of anesthesia; and complications of the procedure were extracted. The data were processed via SPSS version 11.5 and the ?2 test was used to analyze some of the results with the confidence limit set at 95. Results: During the 6-year period; 83 EOH were performed out of 16;249 deliveries giving the rate of the former as 0.51; i.e. 1 in 196 deliveries. However; the case records of only 74 patients (82.9) were available for the study. The rate of EOH increased with advancing maternal age and increasing parity. The majority of the patients (89.2) were available for the study. The rate of EOH increased with advancing maternal age and increasing parity. The majority of the patients (89.2) were unbooked for antenatal care; and the rate of the procedure among these patients (1.82) was significantly higher than 0.07observed amongst booked subjects (P0.001). The main indication for the procedure was ruptured uterus (93.2) and the majority of the patients (95.9) had subtotal hysterectomy. Anemia (66.2); excessive hemorrhage (35.5); septicemia (18.9); and wound infection (16.2) were the leading complications. Excessive hemorrhage was significantly higher in the procedure performed by the senior registrars (51.2) compared to those undertaken by consultants (16.2); P

Emergency Peripartum Hysterectomies at Muhimbili National Hospital; Tanzania: A Review of Cases from 2003 to 2007

Abstract:A retrospective review of all cases of emergency peripartum hysterectomy performed between January 1; 2003 and December 31; 2007 at Muhimbili National Hospital was done to determine the incidence; indications and complications; background characteristics; antenatal care attendance; referral status; and maternal and foetal outcomes. There were 55;152 deliveries during the study period and 165 cases of emergency peripartum hysterectomy; giving the incidence of emergency peripartum hysterectomy of 3 per 1000 deliveries. The main indication was uterine rupture (79) followed by severe post-partum haemorrhage due to uterine atony (12.7). The case fatality rate was 10.3 where as perinatal mortality rate was 7.7 per 1000 deliveries. The common complication identified intraoperatively was severe haemorrhage which accounted for 39.4 where as intensive care unit admissions (14.4) and febrile morbidity (12.4) were common after the operation. Blood was ordered in all cases but in 31 cases it was indicated that it was not available. Seventy nine patients received blood transfusion with the maximum number of units given to one patient being eight. Twenty two patients were given fresh frozen plasma (FFP); the median number of units given was two (range = 1- 6). In conclusion; emergency peripartum hysterectomy is a life saving procedure and very common at MNH. The most common indication was ruptured uterus followed by severe postpartum haemorrhage. More than half of the patients underwent emergency peripartum hysterectomy were referred from other health facilities with ruptured or suspected ruptured uterus. The procedure was associated with unacceptably high maternal and perinatal morbidity and mortality

Morbidity of total abdominal hysterectomy at the university of maiduguri teaching hospital, maiduguri, Nigeria

Total abdominal hysterectomy is a commonly performed gyneacological procedure. Although it is safe, it can still be associated with development of complication. The aim of this study was to determine morbidity associated with total abdominal hysterectomy in our environment.METHOD:All cases of total abdominal hysterectomy done over a five-year period (January 2003-December 2006) at the University of Maiduguri Teaching Hospital (UMTH) were reviewed. Information was obtained from the patients' case notes, gynaecology ward, and theatre records. The complications of the procedure were determined. Multiple logistic regression was used to find the factors that were independently associated with development of complications.RESULTS:During the study there were 101 cases of total abdominal hysterectomy out of 729 gynaecological operations, a rate of 13.8%. In majority of the cases 56 (68.3%) the indication of the hysterectomy was uterine fibroid (symptomatic). Overall 37 (45.1%) experience some form of complication out of which 26 (70.3%) was febrile morbidity Finding enlarged uterus intraoperatively {OR (95% CI) = 14.5 (1.84-114.6), p = 0.011}, blood transfusion {OR (95% CI) = 31.1(1.35-718.8), p = 0.032}and postoperative PCV < 30% {OR (95%CI) = 9.63 (1.14-81.3) p = 0.037} were found to be significantly associated with development of complication. conclusions: Total abdominal hysterectomy was associated with development of complications and enlarged uterus, increasing parity independent risk factors for development of the complication

Management of Complex Urogenital Fistulae in the Female

Objective: To present our experience in the management of complex genitourinary fistulae in the female. Patients and Methods: Between 1995 and 2004; 12 female patients with a mean age of 30 (range 6 - 40) years were managed in our department for various types of complex genitourinary fistulae caused by difficult labor in 6 cases; abdominal hysterectomy in 5 cases and car accident in one case. All patients were subjected to clinical; radiological and endoscopic examination. The fistulae were managed by open surgery. The procedures were individualized according to the existing pathology and included bladder augmentation and construction of a bladder tube. Results: The fistulae were repaired successfully and socially acceptable continence was achieved in all patients. Conclusion: Through urological evaluation of complex urinary fistulae is recommen- ded. The treatment should be individualized based on the existing pathology and may include bladder augmentation and construction of a bladder tube

Obstetric hysterectomy in rural Democratic Republic of the Congo : an analysis of 40 cases at Katwa Hospital

The objective of this study was to determine the incidence, indication, and outcome of obstetric hysterectomy at an Eastern DRC rural hospital. This was a seven year retrospective study. The incidence was 0.28%. Mean age and parity of patients was 35.8 and 7 respectively. Trend to have Obstetric Hysterectomy increased with an age of = 35 years and parity of = 5. The main indications were Post-Partum Hemorrhage (PPH) (40%) and Ruptured Uterus (27.5%). Maternal mortality was 5% compared to 0.18% for Caesarean practiced at the same study period; and perinatal mortality 35.5%. Most indications could be avoided by improvement of Obstetric care. (Afr Reprod Health 2008; 12[1]:60-66)

Pronostic de la rupture utérine au cours du travail : à propos de 293 cas colligés au CHU de Bouaké (Cote d'Ivoire)

L'objectif a été de préciser la fréquence de la rupture utérine au sein de la maternité du CHU de Bouaké et de déterminer le pronostic en fonction de l'éloignement du CHU de Bouaké. Il s'agit d'une étude rétrospective et comparat ive qui s'est déroulée du 1er janvier 1996 au 31 décembre 2001. Cette étude a comparé les caractéristiques et le pronostic materno-fœtal de deux types de patientes : celles issues d'un périmètre de sécurité sanitaire arbitraire défini de 100 kilomètres autour de la ville et celles issues de localités situées au-delà. La fréquence de la rupture utérine a été de 2,44 % soit une rupture utérine pour 41 accouchements. L'hystérectomie a été plus pratiquée dans la population des femmes issues de localités situées au-delà du p é ri m è t re de sécurité sanitaire : 83,34 % contre 28,57 % (p < 10- 4). La létalité de la ru p t u re utérine a été de 11,26 % pour l'ensemble des patientes avec une surmortalité pour celles venues de localités au-delà du périmètre de sécurité sanitaire : 29,91% c o n t re 8,97 % pour celles du péri m è t re de sécurité sanitaire (p = 0,0052). La mortalité fœtale a été de 100 % pour les patientes hors du périmètre de sécurité sanitaire. Les patientes présentant une rupture utérine et évacuées de localités situées au-delà du périmètre sécurité sanitaire ont un pronostic materno-fœtal beaucoup plus sombre

Hypokalaemic nephropathy secondary to enterocutaneous fistula: a rare complication of abdominal hysterectomy

A case of severe hypokalaemia due to enterocutaneous fistula as a post surgical complication of total abdominal hysterectomy is described. The severity of the hypokalaemia resulted in hypokalaemic nephropathy. The polyuria, nocturia and polydipsia were all reversed with appropriate fluid and potassium replacement after the closure of the fistula

Hysterectomies d'indication gynecologique : voie vaginale ou coelioscopie? Experience de la maternite du Centre Hospitalier d'Arpajon

L'hysterectomie est l'une des interventions chirurgicales les plus frequentes au monde. Les voies d'abord sont nombreuses: outre la laparotomie classique qui est de plus en plus delaissee; il y a la voie vaginale et plus recemment la voie coelioscopique. Nous avons voulu savoir si le taux et le type de complications differaient en fonction de la voie d'abord. Notre etude retrospective effectuee sur une periode d'un an; du 1~ janvier au 31 decembre 2004; a la maternite du centre hospitalier d'Arpajon nous a permis d'enregistrer 45 hysterectomies realisees par voie vaginale (51;11pour cent) coelioscopique (28;89pour cent) et coeliovaginale (20pour cent). Nos trois groupes etaient comparables quand a : -L'age qui etait en moyenne de 47;8 ans; -La parite qui etait de 2;5 accouchements; -Les antecedents chirurgicaux et gyneco-obstetricaux. Les principales indications des hysterectomies etaient par ordre de frequence les fibromes uterins (60 pour cent) les saignements uterins anormaux (13;3pour cent) et les tumeurs annexielles benignes (8;89pour cent). Dans tous les cas une hysterectomie totale a ete realisee; associee a une annexectomie dans 28;8pour cent des cas dont 3;4pour cent par voie basse. Nous avons enregistre 4;4pour cent d'incidents per-operatoires dont 2;2pour cent dans le groupe d'hysterectomie vaginale et 2;2pour cent dans le groupe coeliovaginale. Il y a eu plus de complications dans le groupe d'hysterectomie coelioscopique (53;8pour cent) que dans les deux autres surtout les infections. La duree d'hospitalisation etait sensiblement la meme pour les trois groupes soit 4;2 jours

Les hysterectomies : indications; techniques et resultats. A propos de 108 cas colliges dans le Servcie de Gynecologie Obstetrique du CHU de Cocody du 1er Janvier 2001 au 31 Decembre 2002

Notre etude retrospective effectuee sur une periode de 2 ans du ler janvier 2001 au 31 decembre 2002 au service de gynecologie obstetrique du CHU de Cocody nous a permis d'enregistrer 108 hysterectomies toutes indications confondues pour 3370 interventions chirurgicales et 8634 accouchements dont 2449 par cesarienne.Les hysterectomies representaient 3;2pour cent des interventions chirurgicales gyneco-obstetricales majeures.L'age moyen des patientes etait de 41;03 ans avec des extremes de 16 et 71 ans.La parite moyenne etait de 3;97pour cent avec 9;26pour cent de nullipares.Pres de la moitie (47;22pour cent) des patientes etait evacuee et dans un peu plus de la moitie des cas (52;78pour cent) l'hysterectomie a ete realisee en urgence.Les principales indications d'hysterectomies etaient:- les ruptures uterines au cours du travail (37;96pour cent)-le fibrome uterin (28;70pour cent)-les complications des TVG (13;95pour cent)-les cancers gynecologiques (12;04pour cent)-les prolapsus uterins (8;33pour cent)La voie abdominale a ete utilisee dans la majorite des cas (84;26pour cent).Dans 54;63pour cent il s'agissait d'hysterectomies totales contre 39;81pour cent de subtotales et 5;56pour cent d'hysterectomies elargies. Il a ete note 0;93pour cent de complications peroperatoires. Un tiers des patientes a presente des complications postoperatoires dominees par l'anemie (44;74pour cent) et les infections surtout parietales (28;95pour cent). Ces complications sont surtout liees au 'mode de recrutement; a la pathologie initiale; aux modalites operatoires et aux conditions d'hygiene.La duree moyenne d'hospitalisation a ete de 7;08 jours.Il a ete constate 6 deces soit une letalite de 5;56pour cent

Trend of cervical cancer in Seychelles

A 10-year study of all cervical biopsies and hysterectomy specimens received in the Department of Pathology; Victoria Hospital was carried out. Representative punch biopsies of cervix; either colposcope guided; or taken from non-staining areas of cervix following application of Schiller's iodine paint; and fixed in 10 per cent formal saline in the theatre were received in the pathology department. During the ten year period (1983-1992); 175 cases of cervical cancer were detected. Of these; 66 cases were at the CIN 3 stage; 28 were CIN 3 with microinvasion; 69 cases showed frank infiltrating squamos cell carcinoma; 11 exhibited adenocarcinoma and 1 had adenosquamous features

Endometrial adenocarcinoma stage 1a managed by extended Hysterectomy

Summary: A 65-year-old P1 + 0 with postmenopausal vaginal bleeding is presented. She had dilatation and curettage; which showed adenocarcinoma of the endometrium. She had an extended hysterectomy and made an uneventful recovery