[Management of ectopic pregnancy in Conakry, Guinea]. / Prise en charge de la grossesse extra utérine à Conakry (Guinée).

Ectopic pregnancy is one of the most frequent hemorrhagic emergencies encountered in gynecology and obstetrics. The purpose of this 16-month descriptive prospective study at the Ignace Deen Gynecology-Obstetric clinic at Conakry University Hospital in Guinea was to assess diagnostic techniques and therapeutic attitudes regarding ectopic pregnancy in a low-resource setting. The frequency of ectopic pregnancy was 1.4%. Mean patient age was 28.9 years. Ectopic pregnancy was often observed at the second or third pregnancy (47.1%) in women who were giving birth for the second or third time (36.0%) and had a history of sexually transmitted infections (88.2%) or abortions (43.1%). Most women had no schooling (60.8 %), were poor and lived in a marital home (86.3%). Presenting symptoms included the classic triad of amenorrhea (98.0%), abdominopelvic pain (92.2%), and vaginal bleeding (62.7%). Definitive diagnosis was achieved by ultrasound examination in 76.6% of cases and by puncture of the Douglas pouch in 84%. The most frequent site of ectopic pregnancy was the ampulla of the uterine tube (66.9%). Abdominal and ovarian pregnancy was observed in 3 and 4 of the 51 cases respectively. Surgical management was performed in all cases. The most frequent procedure was salpingectomy (80.3%). Proper treatment of sexually transmitted infections (STI), start-up of post-abortion care facilities, and provision of information during early consultation at the first signs of pregnancy would help reduce the frequency and improve the prognosis of ectopic pregnancy.

Prise en charge de la grossesse extra uterine a Conakry (Guinee)

La grossesse extra uterine (GEU) est l'une des principales urgences hemorragiques rencontrees en milieu gyneco-obstetrical. Les auteurs; dans une etude prospective; descriptive; d'une duree de 16 mois a la clinique de gynecologie obstetrique de l'Hopital Ignace Deen du CHU de Conakry; ont ressorti la place des moyens diagnostiques et degage les attitudes therapeutiques dans un contexte de travail ou les ressources sont limitees. La frequence de la GEU etait de 1;4; la moyenne d'age des patientes etait de 28;9 ans. Dans 47;1des cas; la GEU survenait a la deuxieme ou a la troisieme grossesse; chez les femmes qui accouchaient pour la deuxieme ou la troisieme fois (36;0) avec des antecedents d'infections sexuellement transmissibles (88;2) ou d'avortements provoques (43;1). Ces femmes etaient non scolarisees (60;8); issues de milieux defavorises et vivaient dans un foyer conjugal (86;3). La triade amenorrhee (98;0); douleurs abdomino-pelviennes (92;2); metrorragie (62;7) a ete la principale revelatrice de la GEU. L'echographie a ete concluante dans 76;6des cas et la culdocentese dans 84. Le siege de la GEU a ete le plus souvent ampullaire (66;7). Nous avons note 3 cas de grossesse abdominale et 4 cas de grossesse ovarienne sur 51 cas de GEU. Dans tous les cas la prise en charge a ete chirurgicale et le geste le plus frequent etait la salpingectomie (80;3). La prise en charge des IST; l'instauration d'unites de soins apres avortement et la sensibilisation a la consultation precoce devant les signes de grossesse contribueraient a la reduction de la frequence de la GEU et a l'amelioration de son pronostic