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
The puerperal hematoma corresponds to a tissue cleavage, most often paravaginal or vulvar, in which the vascular wounds, linked to the detachment, have no spontaneous tendency to haemostasis. The aggravation of this pathology is progressive. Diagnosis and management must be an obstetric emergency. Author report a case of infected puerperal hematoma complicated by rectal compression and acute retention of urine. This is a 26-year-old patient with a history of chronic hypertension. Labor was induced by misoprostol. The delivery was uneventful at 37 weeks vaginally. Ten days after delivery, she returned to the obstetrical emergency service for acute urine retention. The examination with the vaginal speculum showed a tumefaction of six centimeters on the left lateral side of the vagina. Surgical treatment has been performed. The suite was without particularity. The diagnosis of puerperal hematoma must be early. Even for the delayed form, the complications are identical. Blood loss, compression of proximity organs and infection are the most common complications. The care must be multidisciplinary. Resuscitation of the patient associated with haemostasis of the vessel is the main treatment in cases of large hematoma with hemodynamic instability.
ABSTRACT
Background: Taken care therapeutics of breast cancer is in constant evolution. She links, according to the stadium of illness, a specific treatment of the cancer and mammary reconstruction which makes integral part of the treatment of breast cancer today. The lipofilling or lipostructure is one of the techniques used in mammary reconstruction.Methods: A descriptive retrospective study on lipofilling accomplished in Hospital complex of Dax, France from January 1st, 2016 till October 31st, 2017 was accomplished, to assess the rate of aesthetic and psychological satisfaction of the patients on the basis of breast Q, then to assess its effectiveness and its security. The statistical analysis was made with the software Excel of Microsoft Office 2007.Results: Authors could record 52 lipofillings at 40 patients among 1212 gynecological surgical operations is 4.29% surgical activities. 47 cases (90.38%) of lipofilling were accomplished at 35 patients after a surgery for breast cancer accomplishing a frequency of 3.87% of surgical activity. The women from 49 to 54 years old are the most concerned the median age of which was of 52 years (37 and 73 years) and the patients are still sexually active in 26 cases (74.29%). The mastectomy was practiced in 32 cases (91.45%). An immediate reconstruction was accomplished at 29 (82.86%) patients. The back big rag autologous was used in 22 cases (62.85%). In 33 cases (94.27%), the lipofilling was accomplished to supplement the reconstruction among which by the back big rag at 22 patients (62.5%) and by mammary prosthesis at 11 patients (31.42%). One took a sample in 32 cases of a volume from 400 to 700 ml of grease average of which was 456.38 ml (200-800 ml). A volume from 200 to 300 ml was injected at 17 patients (36.17%) with an average of 264.14 ml (100-600 ml). No repetition of the cancer was recorded during this study. A score of more than 60 was recorded in every domain for the valuation of satisfaction in more than 90% cases.Conclusions: With the evolution of the taking care of the cancers of breast, mammary reconstruction by lipofilling is a technology which goes know a big development. It is a new way of natural reconstruction at the mastectomy patients who wish, more and more a less aggressive surgical gesture with good result.
ABSTRACT
Background: The hemorrhage of the post-partum (HPP) represents a major problem of public health because it hires the vital and obstetrical forecast of the mother in case of delay of taking care. Present study aims at assessing the effectiveness of the administration of 03 tablets of misoprostol in intra-rectal in the taking care of HPP by uterine atony and to determine the épidémio-clinical profile of HPP by atony.Methods: Authors performed a retrospective and descriptive study concerning the effectiveness of the misoprostol in the taking care of HPP by uterine atony. This study started from December 1st, 2016 till March 31st, 2017. The data processing was performed by Epi info 7 and Excel.Results: The rate of HPP represented 3.8% deliveries which 69.4% was due to uterine atony. HPP by uterine atony represented 2.60% deliveries. It happened at the women from 25 to 34 years old (46.16%), pauciparous (76.93%), with a lower working time at 8 hours (71.15%) and having performed at least 4 CPN (63.47%), giving of urgent babies with a medium weight of 3073.43 g. The administration of the misoprostol was efficient in 90.40% and we noticed no side effect or of serious complications during the taking care of HPP by uterine atony.Conclusions: HPP remains another major preoccupation of the obstetricians in our country because it is an emergency that can put into play the vital forecast and which requires a catch in quick load. The administration of 03 tablets (600 µg) of misoprostol in intra-rectal during HPP by uterine atony deserves its place in the armory of taking care because it is a sure method, efficient and easy to manipulate.
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: 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.