ABSTRACT
Background: Preeclampsia is a complication of pregnancy responsible for high rates of morbidity and mortality, particularly in Africa and Madagascar. The objective of present study was to assess patients' knowledge, attitudes and beliefs about pre-eclampsia in Madagascar.Methods: This is an observational study on the knowledge, belief and attitudes of women seen at the Befelatanana Gynecology and Obstetrics Hospital and conducted by questionnaires from 1 December 2017 to 30 May 2018.Results: During the study period, 102 patients agreed to answer our questionnaire. Terminology exists in the local language to describe convulsions and hypertension, but there were no terms that are specific to pregnancy. More than half of our patients knew preeclampsia. In 41% of cases, patients attributed excessive salt intake as a cause of high blood pressure during pregnancy and in 20% secondary to stress. Headache was the best-known symptom of patients. Signs of danger such as epigastric pain, genital bleeding, visual disturbances, convulsions and decreased sensation of fetal movements are not well known to patients. One-third did not know it was lethal. Regarding fetal complications, the occurrence of fetal death in utero was the best known. The majority of patients were aware that blood pressure measurements and urine dipstick testing were mandatory during pregnancy follow-up. To prevent preeclampsia, 46.07% thought that reducing salt intake would reduce the occurrence of preeclampsia.Conclusions: Few patients are aware of preeclampsia, its danger signs and its complications, especially during prenatal consultation. This requires the improvement of knowledge of all health actor. Community health workers should receive basic and ongoing training to facilitate dialogue and information for pregnant and non-pregnant women in each society.
ABSTRACT
Background: Postpartum hemorrhage is the leading cause of maternal death in developing countries. Uterine atony is the cause in 80% of cases. Through this study, we want to determine risk factors for uterine atony after vaginal delivery route with oxytocin-mediated delivery.Methods: This is a retrospective case-control study ranging from January 1st 2017 to June 31st 2018 at the Befelatanana University Hospital Centre of Gynecology-Obstetrics. The cases consisted of patients who had spontaneous vaginal delivery in the centre and had uterine atony. Authors studied maternal, obstetrical, neonatal parameters. Authors used the R software for the statistical analysis of the results.Results: We found 40 cases of uterine atony out of 5421 deliveries with a prevalence of 0,73%. The average age was 27.73 years old±6.46 years old (p=0.113). The average parity was 2.67±1.62 (p=0.22). The total duration of labor was 6.88±2.95 hours (p=0.0187). The average duration of rupture of the membrane was 5.80±11.90 hours (0.003376). We found as risk factor of uterine atony the increase in oxytocin infusion rate during labor (OR=18.67, 95% CI 2.21-157.57), the artificial rupture of membranes (OR=5, 27, 95% CI 2.11-13.19), artificial induction of labor (OR=7.08, 95% CI 2.06-24.28) and labor over six hours (OR=2.53, 95% CI) % 1.18-5.47). In univariate analysis, premature delivery and a hypotrophic fetus were a factor risk of uterine atony (OR=3.07, 95% CI 1.27-7.44 and OR=3.43 95% CI 1.48-8.09 respectively) but this risk is not statistically significant in multivariate analysis with logistic regression (OR=1.27, 95% CI 0.40-3.84 and OR=2.19 95% CI 0.77-6.22). The main treatment was uterotonic drug use (72.5%). Authors identified seven cases of haemostasis hysterectomy and two cases of maternal death.Conclusions: Present study confirms risk factors for uterine atony already known as prolonged labor and increased oxytocic infusion rate. Unrecognized factors have been identified as a risk factor for uterine atony such as the duration of rupture of the membranes and artificial rupture of the membranes. A minimal inflammation hypothesis that reduces susceptibility to oxytocin may explain this association. Knowing these factors would reduce the occurrence of uterine atony to reduce maternal mortality.