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 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: 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.