ABSTRACT
The rectovaginal fistulas are a pathological epithelialized communication between the vagina and the rectum, its frequency is 10 to 30%, and it is a disabling pathology because of the social repercussion. Many flap techniques have been described but the aim is to present a simple procedure according to a particular technique called Martius. This is a case of woman presenting a low rectovaginal fistula on obstetrical trauma. The surgical technique consists of a repair according to the technique of Martius. The operative follow-up was simple and the patient was able to resume sexual activity and normal anal sphincter function. It is a simple technique, easy to achieve for the technical platform in Madagascar whose evaluation of the results for a larger population should be considered. This technique therefore deserves to be known and widely used.
ABSTRACT
Background: The chorioamnionitis corresponds to an infection of the ovular cavity. She puts game neonatal and maternal forecast. This study had as objectives to describe the epidemiological aspects, the taking care and the forecast of the chorioamnionitis to the gynecology teaching hospital and obstetrics Befelatanana, Madagascar.Methods: It is about a descriptive, retrospective and transverse study, during a period of 6 months going from January, 2016 till July 2016. The pregnant women introducing a premature break of membranes (RPM) complicated with chorioamnionitis hospitalized in CHU-GOB during this period had been included.Results: Authors found 35 cases of chorioamnionitis, that is 38.1% premature breaks of membranes. The medium age of the patients was 20±5, 16 years old (extreme from 17 to 36 years). Primiparous was found in 82.9%. The chorioamnionitis had happened in 68.5% cases after 37 weeks of amenorrhea. The delay between RPM and happened of chorioamnionitis was of 6 hours. The picture of chorioamnionitis was complete in 54.3%. Delivery was by low way in 33.3%. Authors had found 88.60% case of endometritis, 8.6% case of parietal suppuration post caesarian section but without any maternal decease. Neonatal complications were marked by a score of Apgar <7 - five minutes in 74.3%, neonatal infection in 25.7% and precocious neonatal decease in 11.4%.Conclusions: The chorioamniotite concerned primiparous especially young urgent. The application of the protocol of taking care of the premature break of membranes is necessary for the reduction of the happening of the chorioamniotitis.
ABSTRACT
Background: Color code was described for the first time in 2003 was described for the first time in 2003 by since and al. The objective of this study was to accomplish urgent caesarian sections according to color code over delays indications-births (DIN) in Motherhood Befelatanana, Antananarivo, Madagascar.Methods: It was about a longitudinal prospective, analytical study of caesarian sections performed in emergency in CHUGOB going from June 1st till December 31st, 2017.Results: Authors took a census 193 caesarian sections of emergency. Among these patients 28 (14.50%) had a caesarian section encode red, 42 (21.76%) an orange code and 123 (63.73%) a green code. The medium age of the patients was of 26.4 years and that of the gestation was of 37SA and 6 days. The delay indication-birth (DIN) medium was of 102.9 minutes for red code, 99.7 minutes for orange code and 75 minutes for green code.Conclusions: Authors could not attain DIN of 30 minutes shape in international recommendations. Authors must improve the delay indication entered in the surgical unit by reinforcing knowledge of the agents of support on the management of emergency obstetrical. The possibility of leading to a very quick birth is an indisputable progress in obstetrics but she should not make forget risks inherent in such procedure.
ABSTRACT
Background: Postpartum hemorrhage (PPH) remains the main cause of maternal death throughout the world. present goal was to determine the associated factors to maternal death in postpartum hemorrhage.Methods: This was a retrospective case-control study; carried out within Befelatanana maternity, in Antananarivo, from January 1st, 2013 to December 31st, 2015, on parturients who presented PPH. The cases were represented by the parturients who died despite well-managed care, and the control, by the living parturients.Results: Authors recorded 181 cases of PPH from 20,888 deliveries, with a prevalence of 0.86%; 47 of them died and 134 were alive; the mortality rate by PPH is 25.96%. Factors associated with death were low education (p=0.00 OR:3.2), non-working (p=0.01, OR:2.4), multiparity ( p:2.2 OR:0.01), absence of prenatal care (p:0.01 OR:2.2), cesarean section (p:0.00 OR:5.5); Intrauterine Fetal Death (p= 0.02, OR:2.2); uterine atony (p=0.03, OR 2.1); the state of shock (p=0.00 OR:57.8), sanitary evacuation (p=0.01 OR: 2.4), the need for blood transfusion (p=0.00 OR: 3, 7), use of catecholamines (p=0.00, OR:17.5); delayed management (p=0.01, OR:2.2), hemostasis hysterectomy (p=0.00 OR: 8.67).Conclusions: The decrease of maternal mortality related to PPH requires better monitoring of pregnancy, delivery and postpartum. Speed care management, improvement of technical platform and establishment of a powerful health system are also needed. Thus, the global reduction of poverty is indispensable.