Epidemiolpgie de la macrosomie

The purpose of this work is to study the epidemiological profile of macrosomia in the Moroccan context stressing on the aetiological factors. Material and methods: We studied pregnancy and delivery of 2160 macrosomal cases during a period of four years [1994-1997]. We adopted the correlation coefficient for the statistical study. The macrosomal frequency was 7,5%. Specially in young parturient women aged 20-30 years, multipara, fatty, tall, diabetic, having had previous antecedents of a macrosomian newborn and having a fundal level more than 35 cm. Delivery was normal in 90,7%, assisted by ventouse in 32% and forceps in 3% of cases. The caesarean section was practised in 9,3% of cases. The neonatal morbidity in the for of distress was [6%], paralysis of brachial plexus in [2,1%], fracture of the clavicle or humerus [0,3%] and one case suffered from facial paralysis. Maternal morbidity was mainly dominated by post-partum hemorrhage [1,9%], infections and uterine rupture [0,8%]. The foetal macrosomia raises many problems: the best way to confirm its diagnosis is by using the echography although it has a high error margin. The question here is starting at what weight should the prophylactic caesarean section be done systematically

Pregnancy and delivery among adolescent

The high risk of adolescent pregnancy is due to morphologic, socio-economic and psychologic factors and to the lack of prenatal supervision. In a retrospective study about 508 adolescents, we tried to emphasize the specific aspects of moroccan adolescent women. The unmarried ones represented 15%, mainly very young girls. The incidence of the preclampsia was 6%. The rate of premature delivery was 8%. These complications seen to be due to the lack of prenatal supervision and to the unmarried status of the adolescent. The delivery was most often eutocic. The instrumental extraction was necessary in 20,43% of the cases especially because of bad maternal cooperation at the expulsion. The caesarian section has been practiced in 5.12% of the cases. The average weight of newborns of unmarried women was by 280 grammes lower compared to newborns of married women. The weak neonatal weight [2500 grammes] was noticed in 12% of the cases mainely related to prematurity. The perinatal mortality represented 36.3% births. The pregnancy of adolescents doesn't seem to be subjet to high medical risk, provided that it takes advantage of prenatal follow up and adequate supervision

Ligation of the hypogastric arteries in the obstetrical hemorrhage. About 3 cases

The authors report their experience in surgical treatment of main obstetrical hemorrhage of delivery due to placenta praevia or to the uterine inertia, refractory to the classical medical treatment [uterine manual massage, methyl ergobasine, intra-venous or intramural syntocinon perfusion]. They intend the bilateral ligature of hypogastric arteries which is simple, swift and effective process allowing to save mother by stoping uterine bleeding which often put in danger the patient life. This technic allow as well to avoid hysterectomy, a much long intervention to realise and mainly mutilating for a young women, and only effective in the case of localised uterine lesion. Finally authors insist on the great attention of obstetriciens during the technical realisation of bilateral ligature of hypogastric arteries and on the absence of clotting troubles which makes surgical process uneffective