Bilan des activités d'Anesthésie au service de Gynécologie - Obstétrique du Centre de Santé Gaspard Kamara, Dakar (Sénégal)

Objectifs : Faire le bilan des activités d'anesthésie au Centre de Santé Gaspard Kamara et proposer des recommandations pour améliorer la qualité des soins.Patientes et méthodes :Il s'agissait d'une étude rétrospective, descriptive et analytique allant du 1er Janvier au 31 Décembre 2012 et incluant toutes les patientes ayant bénéficié d'une anesthésie et dont les dossiers étaient retrouvés et exploitables. Le personnel du service d'Anesthésie-Réanimation était composé d'un médecin anesthésiste ­ réanimateur et de 5 techniciens supérieurs d'anesthésie dont 3 vacataires à temps partiel. Les paramètres étudiés étaient le profil épidémiologique des patientes, l'indication de l'anesthésie, les données de la consultation pré anesthésique, l'anesthésie peropératoire, la prise en charge postopératoire, les complications et les facteurs influençant le choix de l'anesthésie. L'exploitation statistique des données était effectuée à l'aide du logiciel SPSS version 20.0.Résultats : Durant la période d'étude, nous avons pris en charge 5147 patientes. Parmi celles-ci, 1256 ont bénéficié d'une anesthésie, soit un taux de 24,4%. Nous avons exploité 1033 dossiers (82,2%) qui répondaient aux critères d'inclusion. Le profil épidémiologique était celui d'une femme âgée en moyenne de 28 ans, primipare (50,4%), avec une parité moyenne de 2 et ayant déjà bénéficié d'une anesthésie. Près de la moitié des patientes (46,7%) étaient classées ASA 1. La césarienne était l'indication d'anesthésie la plus fréquente (91,2%) et la majorité des interventions étaient pratiquées dans un contexte d'urgence (87%). L'anesthésie peropératoire était réalisée par les techniciens supérieurs d'anesthésie dans 95,8% des cas. La rachianesthésie était la technique la plus pratiquée (86,9%). L'analgésie postopératoire associait le plus souvent le paracétamol au tramadol (76,8%). Des complications peropératoires étaient dominées par l'hypotension artérielle (10,8%). Un seul décès (0,1%) était enregistré et il n'était pas directement lié à l'anesthésie.Conclusion : La pratique de l'anesthésie est fréquente en Gynécologie Obstétrique. La faible incidence des complications observées dans notre série ne doit pas masquer les difficultés rencontrées au quotidien dans notre pratique. Pour améliorer la qualité des soins en anesthésie, nous devons augmenter l'effectif des ressources humaines qualifiées en anesthésie-réanimation et relever le plateau technique

[Epidemioclinical and legal aspects and cost management of sexual abuse among minors in Dakar, Senegal]. / Aspects épidémiocliniques, juridiques et coût de la prise en charge des abus sexuels chez les mineurs à Dakar, Sénégal.

OBJECTIVES: Specify epidemioclinical and legal aspects of sexual abuse among minors and evaluate the cost of care in Dakar. MATERIALS AND METHODS: This is a retrospective multicenter cross-sectional study on sexual abuse among minors over a period of four years from 1st January 2006 to 31st December 2009. Four maternities were targeted: the Social Hygiene Institute of Medina, health center Roi-Baudouin Guédiawaye, the Pikine hospital and health center Youssou-Mbargane-Diop of Rufisque. RESULTS: During the study period, 252 child victims of sexual abuse were supported at four health facilities on a total of 272 sexual abuses of all ages, a frequency of 92.64%. The epidemiological profile of our patients was a child of 11 years old on average, female (100%) and living in the suburbs of Dakar (68.1%). Children were often abused during working hours (31.7%), outside the family environment and often by someone known to the victim (72.6%). Genito-genital contact was the most common mode of sexual contact (80.9%) with vaginal penetration in 61% of cases. Almost all of the victims (92.1%) came to consult, accompanied by their parents, between the 1st and 4th day after the sexual abuse (70%). The examination usually revealed a hymenal trauma (59.9%) of which nearly half (49%) consisted of old lesions. 56.9% of victims had a post-traumatic stress disorder and 31.1%, mutism. We recorded six (6) pregnancies, 2% of our sample. A case of HIV infection was recorded on a sample taken 72hours after sexual abuse. Control of three months HIV serology was requested in 7.1% of cases and only 20% of children had received antiretroviral prophylaxis. Antibiotic prophylaxis had been performed in 13.7% of cases using doxycycline as drug of choice (75%). Only 29% of our patients had received emergency contraception progestin and psychological care concerned only 22% of children. On the legal aspects, 46% of our patients had filed a complaint. Prosecutions were 38%, 45% of which were convicted and 21% were acquitted. The rate of out-of-court settlement was 35% and the time limit for settlement by the justice was on average 6 months with extremes of one month and 24 months. The average cost of care was estimated at 17,010 CFA francs (26 euros) taking into account the consumables used for clinical examination (sterile gloves, catheter, syringe), analysis and prescription drugs. CONCLUSION: The sexual abuse of minors is a disturbing reality that raises rightly universal reprobation. In Senegal, this mainly affects children and its magnitude is increasing over the years. Improved support for victims necessarily involves raising public awareness through the media and the development of specialized structures in the management of sexual abuse.

[Pregnancies associated with valvular prosthesis at Dakar Teaching Hospital: prognosis, epidemiological, clinical and therapeutical aspects]. / Prothèse valvulaire cardiaque et grossesse au CHU de Dakar: aspects épidémiologiques, cliniques, pronostiques et modalités thérapeutiques.

OBJECTIVE: The persistence of the rheumatic valvular cardiopathie and the access to cardiac surgery make this association frequent. This work will deal with a description of the epidemiological and clinic profile and the evaluation of the cares to the pregnancies with cardiac valvular prostheses. METHODOLOGY: We took a retrospective study beginning from 1987 to 2006 about 14 cases, which had benefited from collaboration between the Gynaecologic and Obstetric Clinic and the Cardiological Clinic of the University Hospital Center of Dakar. RESULTS: The frequency of pregnancies with valvular prosthesis was of 0.12 per thousand. The average age of our patients was of 27.7 years. The average pregnancy was of 2.3 gestures with extremes of 1st to 12th gestures. The pregnancies were not, in any case, planned. An auricular fibrillation was noticed in four patients. The fraction of ejection of the left ventricle was superior or equal to 60% in 10 cases, the prosthesis was lightly blocked in two cases. Despite the use of anti-vitamin K during the first trimester with 42.86% of the patients, the anticoagulation was effective with the entire cases excepted one who died by lung embolism. The delivery was, in seven cases, realized by caesarean and in two cases by natural way. Two cases of premature and foetal hypotrophy have been noticed. There was no case of malformed children. CONCLUSION: With a multidisciplinary care, the carry of valvular prosthesis can be compatible with pregnancy. The lack of embryopathy and malformed children could incite to propose the oral anticoagulation during the whole sequence of pregnancy.

[First-trimester abortion at University Hospital Center in Dakar, Senegal: utility of manual vacuum aspiration]. / Avortements du premier trimestre au chu de Dakar: interêt de l'aspiration manuelle intra-uterine.

The purpose of this retrospective study was to evaluate the utility of the manual vacuum aspiration (MVA) for management of incomplete first-trimester abortions. All patients treated for incomplete first trimester abortion using MVA under local anesthesia at University Hospital Center in Dakar from January 1, 2002 to December 31, 2003 were included. A total of 2379 pregnancy losses were recorded among the 14476 patients admitted during the study period. First-trimester abortion was treated using the MVA method under local anesthesia in 1372 cases (57.7%). For 87% of patients, the duration of hospitalization was less than 12 hours. The epidemiological characteristics of these women were young age (mean, 29 years old), low parity (mean, 2 children) and low gestational age (mean, 10 weeks after amenorrhea). Spontaneous abortion accounted for 94.4% of cases and clandestine abortion for 5.6%. No complications occurred during MVA procedures and no morbidity was observed with a follow-up of one year. These findings show that MVA is a safe and effective method for completing incomplete first-trimester abortions. In our practice use of this simple technique led to a considerable improvement in post-abortion care.

Avortements du premier trimestre au CHU de Dakar: interet de l'aspiration manuelle intra-uterine

L'objectif etait d'evaluer l'interet de l'aspiration manuelle intra-uterine (AMIU) sous anesthesie locale dans la prise en charge des avortements du premier trimestre. Il s'agit d'une etude retrospective concernant toutes les patientes prises en charge au CHU de Dakar par AMIU pour un avortement du premier trimestre entre le 1er janvier 2002 et le 31 decembre 2003. Pendant le periode etudiee; nous avons enregistre 2379 grossesses arretees parmi une population de 14476 entrantes. Dans 1372 cas (57;7) il s'agissait d'avortements du premier trimestre qui ont ete traites par l'AMIU ; pour 87des patientes; la duree d'hospitalisation etait inferieure a 12 heures. Le profil epidemiologique est celui d'une patiente agee en moyenne de 29 ans; paucipare (parite moyenne de 2) porteuse d'une grossesse dont l'age gestationnel moyen etait de 10 semaines d'amenorrhee. Dans 1296 cas (94;4) l'avortement etait spontane; alors que dans 76 cas (5;6) il a ete provoque clandestinement. Aucune complication liee a la procedure n'a ete enregistree et le suivi post-abortum n'a revele aucune morbidite avec un recul d'au moins 1 an. L'AMIU est une methode efficace et sure pour evacuer l'uterus dans les avortements incomplets du premier trimestre. C'est une technique simple qui a ameliore considerablement la qualite des soins apres avortement dans notre pratique

Avortements du premier trimestre au CHU de Dakar: interet de l'aspiration manuelle intra-uterine

L'objectif etait d'evaluer l'interet de l'aspiration manuelle intra-uterine (AMIU) sous anesthesie locale dans la prise en charge des avortements du premier trimestre. Il s'agit d'une etude retrospective concernant toutes les patientes prises en charge au CHU de Dakar par AMIU pour un avortement du premier trimestre entre le 1er janvier 2002 et le 31 decembre 2003. Pendant le periode etudiee; nous avons enregistre 2379 grossesses arretees parmi une population de 14476 entrantes. Dans 1372 cas (57;7) il s'agissait d'avortements du premier trimestre qui ont ete traites par l'AMIU ; pour 87des patientes; la duree d'hospitalisation etait inferieure a 12 heures. Le profil epidemiologique est celui d'une patiente agee en moyenne de 29 ans; paucipare (parite moyenne de 2) porteuse d'une grossesse dont l'age gestationnel moyen etait de 10 semaines d'amenorrhee. Dans 1296 cas (94;4) l'avortement etait spontane; alors que dans 76 cas (5;6) il a ete provoque clandestinement. Aucune complication liee a la procedure n'a ete enregistree et le suivi post-abortum n'a revele aucune morbidite avec un recul d'au moins 1 an. L'AMIU est une methode efficace et sure pour evacuer l'uterus dans les avortements incomplets du premier trimestre. C'est une technique simple qui a ameliore considerablement la qualite des soins apres avortement dans notre pratique

[Etiologic factors of prematurity in Ziguinchor maternity hospital center (Senegal)]. / Facteurs étiologiques de la prématurité au centre hospitalier régional de Ziguinchor, Sénégal.

A case-control study was conducted between September 2003 and January 2004. Fifty four newborn babies born before 37 weeks of gestation resulting from 47 pregnancies including 7 multiple pregnancies were compared to 105 newborn babies born between 37 and the 42 weeks of gestation. Parturient geographical origin, marital status, age, alcohol or tea consumption and height were not significantly associated to premature birth (p > 0.05). On the other hand, a higher parity or equal to 3, a number of antenatal care lower than 3 were significantly associated with the risk of premature birth (p < 0.05). But a gestity and a parity lower than 3 and a number of antenatal consultations higher or equal to 3 had a protective effect (OR < 1; p < 0.05). We recommend a reinforcement of malarial prevention during pregnancy according to WHO recommendations and the improvement of the quality of the antenatal care in the Ziguinchor medical district.

[Time-course of neonatal precocious mortality between 1994 and 2003 at the Dakar University Teaching Hospital]. / Evolution de la mortalité néonatale précoce entre 1994 et 2003 au CHU de Dakar.

OBJECTIVE: To evaluate early neonatal mortality at the University Teaching Hospital and assess changes in the rate and causes during the last ten years. MATERIAL AND METHOD: We performed a retrospective analysis of neonatal deaths recorded at the Neonatal and Premature Unit (NPU) in 2003. The results were compared with earlier evaluations. Comparison of proportions was used for statistical analysis to eliminate the random element in rate variations. The significance threshold was < or =5%. RESULTS: We registered 364 neonatal deaths: 243 among 4853 newborns in our maternity ward and 121 among 213 newborns transferred from a referring maternity. Early neonatal mortality rate 45.5 per 1,000 live births. Mortality particularly concerned newborns with a birth weight < or =2,500 grams (66%) and Apgar scores < or =6. Early neonatal mortality fell significantly since 1994, while overall mortality remained high among newborns transferred from referring maternities. The most frequent causes were premature birth (49%), acute fetal distress (23%) and neonatal infection (18%). CONCLUSION: Early neonatal mortality has decreased remains at a high level. It could be improved by limiting the number of premature births, neonatal suffering and neonatal infection. In a parallel direction we recommend organizing a perinatal network in Dakar.

[Efficiency of kangaroo care on thermoregulation and weight gain of a preterm newborn cohort in Dakar]. / Efficacite de l'elevage par la methode kangourou sur la thermo- regulation et le gain ponderal d'une cohorte de prematures.

AIM OF THIS STUDY: to evaluate the efficacy of kangaroo method on thermoregulation and weight gain of a cohort of preterm. METHODS: it is a retrospective study based on files of preterm baby weighting below 2000 g, included after discharge to neonatal unit of Aristide Le Dantec maternity for kangaroo method care. Efficiency was appreciated on thermic curve evolution and daily weight gain. RESULTS: 56 preterm babies were including. Mean gestational age was 33 +/- 7,6 weeks and mean birth weight, 1488 +/- 277,6 g (median = 1500 g). Mean temperature was satisfying during follow up and was stable around 37 +/- 0,5 degrees C at discharge of program with mean daily weight gain of 33 +/- 7,6 g. We had only one case of death. CONCLUSION: The results of this study point out efficacy of kangaroo method on thermoregulation, weight gain and survival of preterm babies. We advocate for promotion in developing countries because of its low cost.

[Trial of labor in moderate pelvic dystocia at Dakar University Teaching Hospital]. / Epreuve du travail dans les dystocies osseuses modérées au CHU de Dakar.

OBJECTIVE: To study frequency of moderate pelvic dystocia, to evaluate the diagnosis value of clinical pelvic evaluation and prognosis of trial labor with only clinical monitoring. MATERIAL AND METHOD: This is a prospective, exposed and non-exposed study concerning 296 women selected among deliveries presenting moderate pelvic dystocia recorded at Dakar University Teaching Hospital from February 1st 2001 to July 31 2002. Trial labor was undertaken in 148 patients; the control group was chosen among women who underwent prophylactic caesarean section and had no other risk factors of maternal and perinatal complications. Pearson's chi-square test was used or statistic analysis with p value 5% and test of Kappa. RESULTS: Moderate pelvic dystocia was observed 5.3 per 100 deliveries. The most common epidemiological profile was primipara, young age (mean 24 years), height 161 cm (mean), 38-week pregnancy (mean). Clinical evaluation had good diagnosis value comparable with the radiological pelvimetry. Trial labor was undertaken in 148 women, 109 trials (73.6%) were successful; vaginal delivery rate was 27% in women with moderate pelvic dystocia. There were no maternal deaths, maternal morbidity was 4% in trial labor patients and 2.7% in prophylactic caesarean section patents (mainly infection). Post-natal mortality was 7.4% after trial of labour versus 4.1% of newborn child after prophylactic caesarean. CONCLUSION: These results confirm that trial of labor on moderate pelvic dystocia should be the rule whenever possible, even when only clinical monitoring is available.

[Ovarian fibroma associated with Demons-Meigs syndrome and elevated CA 125]. / Fibrome de l'ovaire associé à un syndrome de Demons-Meigs et à une élévation du CA 125.

We report a rare case of ovarian fibroma in a young woman. When ovarian masse is associated with Meigs' syndrome and elevated CA 125 serum level a malignant process may be suspected. But a negative cytological examination of ascitic effusion and absence of peritoneal implant recommend performing limited surgical procedures.

[Thinking about the evolution of caesarean section rate at University Teaching Hospital of Dakar between 1992 and 2001]. / Réflexions sur l'évolution des taux de césarienne en milieu africain : exemple du CHU de Dakar entre 1992 et 2001.

OBJECTIVE: The objective of this study is to answer the question: have we not been doing a lot of caesarean sections at University Teaching Hospital of Dakar? PATIENTS AND METHOD: This is an analytic study about caesarean section in 1992, 1996 and 2001; it was a prospective and longitudinal data collection from the epidemiological survey program carried through in Senegal about its obstetrical and surgical cover. For each year concerned, we have analysed caesarean section rate, maternal mortality rate and perinatal mortality rate. To eliminate the random part in observed variation, we used the comparison of proportions observed as a statistical test with a significant threshold less or equal to 5%. RESULTS: Caesarean section has gone from 12% in 1992 to 17.5 in 1996 and 25.2% in 2001. Operative indications are dominated by foeto-pelvic disproportion with an average of 31% and foetal suffering with an average of 25%. The increasing trend has been statistically significant for information's such as foeto-pelvic disproportion and maternal pathologies. The falling trend was statistically significant for indications in relation on relation to foetal suffering and scarred uterus. Gathering information has shown a stabilisation of "obligatory" caesarean rate around 41%, a decrease in "caution" caesarean rate from 50 to 37.2% and an increase in caesarean by "necessity" from 8.6 to 22.4%. The maternal mortality rate among women delivered has fallen from 1.4% to 0.8%, but postoperative surgery morbidity rate was still high around 10%, essentially due to infections. Reading of caesarean section rate has not a significant impact in perinatal prognosis. DISCUSSION AND CONCLUSION: Today there is an inflation of caesarean section at University Teaching Hospital of Dakar, without any significant loss of the maternal and perinatal mortality rate. The high level of complications due to surgery incite to reverse trends in order to get reasonable rate around 10 to 15% of childbirths.

[Preeclampsia: current aspects of physiopathology, clinic and treatment]. / Prééclampsie: physiopathologie, aspects cliniques et thérapeutiques actuels.

Preeclampsia complicating 3-5 % of all pregnancies in the world. Its origin is abnormal placentation around 12th week pregnancy. It associates hypertension and proteinuria appeared after 20th week pregnancy. Many risk factors with various mechanism of action have been identified (primigravida, younger age, twin pregnancy...). The main consequence of placental ischemia is generalized endothelial dysfunction responsible for clinical symptoms and complications (eclampsia, placental abruption, HELLP syndrome). It's an important cause of maternal death and is associated with increased risk of neonatal mortality, particularly in developing country. There is no consensus with regard to management particularly utilisation of drugs and break indication of pregnancy. Low dose aspirin is the only efficient preventive strategy in high-risk subjects. The therapeutic aspects are discussed as many in the benefit and the modalities of the antihypertensive treatment, as the indications of pregnancy interuption. Prevention is an up coming way but for the moment, only acetylsalicylic acid has proven its efficacity among the high risk patients.

[Epidemiology and prognosis of caesarean sections in University Hospital of Dakar]. / Epidémiologie et pronostic des césariennes au CHU de Dakar.

Caesarean section is our first activity in obstetrical surgery. Due to his high frequency and the maternal and foetal prognostic, we have undertaken to do a prospective, longitudinal, exhaustive study concerning all women whose delivery necessitated a caesarean section, between 01 January and 31 December 2001 in Gynaecological and Obstetrical Clinic of University Hospital Center Le Dantec. Our objectives were: describe the epidemiological aspects, evaluate the maternal and foetal prognosis of caesarean sections performed in University Hospital Center. The study revealed that 25.1% of births necessitated a caesarean section. The average age was of 26; the mean parity of 2; the medium height of 161cm. 26.4% of patients were evacuated and coming from the health centers in majority (41.9%) with unmedicalised evacuation in 44.9% of cases. 78.7% of patients have realised at least 3 antenatal consultations. The mains indications were cephalopelvic disproportions (34.9%) and foetal distress (18.9%). The classification per indications group revealed that 37.2% were "prudence caesarean section", 40.1% were "obligator's caesarean section" and 22.7% "necessity's caesarean section". The mean Apgar's score at the birth was 6,5 at first minute. 12 maternal deaths were noted, means 0.8% of global lethality; the morbidity was at 10.5% of cases, represented mainly by postoperative infection (64.3%). The per natal mortality was estimated to 5.9% and neonatal morbidity to 32%. About the quality of caesarean sections, the temporal (24h/24) and financial(kit of caesarean section) accessibilities are more satisfying; otherwise the quality of surgical act and the postoperative follow-up was not optimal. An inflationist advancement is actually noted about the rate of caesarean section, and due to the widening of the indications to the foetal interest. Nevertheless, despite agreed efforts, the quality is still insufficient because the maternal and per natal morbidity and mortality are still high.

[Epidemiology, prognosis and prevention of choriocarcinoma in University Hospital of Dakar]. / Epidémiologie, pronostic et prevention du choriocarcinome au CHU de Dakar.

The objective of this study was to define epidemiological profile of choriocarcinoma in Senegal, to evaluate its prognosis and to submit a better strategy of prevention. It's a retrospective cases-control study; all choriocarcinoma diagnosed from January 1st to December 31st 2000 at Dakar University Teaching Hospital. The control were chosen among patients who had molar abortion during the same time than the cases and did not developed the pathology after at least 12 months of medical follow up. The stability of association is checked by calculating 95 confidence interval by Miettinen method, and using Chi 2 test of Pearson with a p value of 5% or Fischer test; the prognosis survival factors was compared using logrank test. Among 1098 patients with medical care follow up of post molar abortion, 61 choriocarcinoma were diagnosed with an incidence of 5.5%. The epidemiological profile is a great multipare 40 years old or more with low socio-economical status, 51% of diagnosed cases was in metastasis stage. The prognosis was marked by a complete remission in 37.7% and by global lethality in 49.2%; the average survival was about 48 months. The risk factors of choriocarcinoma among patients who had a molar abortion are represented by an age superior or equal 40 years old, high multipare and preservation of the uterus after molar abortion. To improve the prognosis we recommend to widen preventive hysterectomy indications after molar abortion among patients with risk factors of choriocarcinoma.

[Therapeutics indications and prognosis of eclampsia at Dakar University Teaching Hospital]. / Indications thérapeutiques et pronostic de l'éclampsie au CHU de Dakar.

OBJECTIVE: To study the factors of risk of complications and evaluate the quality of medical and obstetrical management of eclampsia. METHODOLOGY: We performed a retrospective analysis of all cases of eclampsia recorded during the ante- or per partum period from January 1, 2000 to December 31, 2001 at the gynecological and obstetrical clinic at Dakar University Teaching Hospital. RESULTS: Eclampsia had concerned 78 patients, with an incidence of 8 per 1000 childbirth. The epidemiological profile was primipara (68%), young (average age: 20 years), 36 weeks pregnancy or more (60,3%), evacuation in a state of post critical coma (74.3%), on average after 2 seizures, without medical assistance (64%) with an average diastolic blood pressure of 100 mm Hg. Examinations with strong prognosis value like blood count, creatininemia, coagulation, hepatic transaminases and uricemia were not available in emergency (only 24% of all cases). Medicines prescribed included, nicardipine (63%) and magnesia sulfate (53%); this medical treatment was satisfactory in 34.6% of the cases. Cesarean section was performed in 50%. The prognosis was marked by 17.9% maternal mortality and a perinatal mortality of 359 per 1000 births. The principal risk factors of maternal and perinatal complications were early-onset eclampsia, large number of seizures and late obstetrical treatment. CONCLUSION: Prehospital treatment and availability of early cesarean section must be better organized to improve the prognosis of eclampsia.

[Threatened preterm labour: assessment of its management at the Dakar University Teaching Hospital]. / Evaluation de la prise en charge des menaces d'accouchement prématuré au CHU de Dakar.

The objective is to specify epidemiological profile of pre term labour birth and evaluate the efficiency of the tocolysis protocol of Dakar University Teaching Hospital. It's a retrospective study which included 155 cases of spontaneous premature birth registered from January 1st 2000 to December 31 2002 in obstetrician clinic. The incidence is 15 per 1000 childbirth. The epidemiological profiles on a pauciparous woman (mean age: 25 years), of low economic and social level (90%), admitted with a bad antenatal follow-up and a pathology associated with pregnancy dominated by arterial hypertension (25%). The mean age of gestation is 30 weeks; severe forms are prevalent and tocolysis score of Baumgarten is equal or higher than 4 in 71.6%. The three principal etiologists are toxaemia, premature rupture of membranes and infections. An association Salbutamol-Phloroglucinol is carried out in 28 cases (18%) or with Phloroglucinol in 25 cases (16.1%). In summary, 138 patients (89%) were finally confined by low way after 5 hours a median time. Perinatal mortality was 347.2 per 1000; it's related to the large premature ones particularly having a weight of birth less than or equal to 1300 grams (78%). The threats of pre term labour are often diagnosed tardily. The access to the tocolysis in emergency is limited and it's effectiveness practises very weak. Use of calcic inhibitors and the systematisation of corticotherapy should improve the forecast of prematurity.

[Choriocarcinoma in Senegal: epidemiology, prognosis and prevention]. / Choriocarcinome au Sénégal: épidémiologie, pronostic et prévention.

OBJECTIVE: The objective of this study was to define the epidemiological profile of choriocarcinoma in Senegal, to evaluate its prognosis and to submit a better way of prevention of this pathology in an area with poor medical care. MATERIAL AND METHOD: It was a retrospective case-control study of all choriocarcinomas diagnosed from January 1st to December 31st 2000 at Dakar university teaching hospital. The witnesses were chosen among patients who had had molar abortion at the same time as the cases at study and had not developed the pathology after at least 12 months of aftercare. The stability of association was checked by calculating the confidence interval in 95% by Miettinen method and using Chi 2 test of Pearson with a risk factor alpha under 5% or Fischer test; the prognosis survival factors were compared by using logrank test. RESULTS: Among the 1098 patients in follow-up treatment after molar abortion, 61 choriocarcinomas were diagnosed with an incidence of 5.5%. The epidemiological profile was a great multiparous (40 years old or more) with low socio-economical level, 51% of the diagnosed cases are made in the metastasis stage. The prognosis was marked by a complete remission in 37.7% and by global lethality in 49.2%; the average survival was about 48 months. DISCUSSION AND CONCLUSION: The risk factors of choriocarcinoma among patients who had a molar abortion were represented by an age superior or equal to 40 years old, high multiparity and preservation of the uterus after molar abortion. To improve the prognosis in a country with low medical care, we recommend to widen preventive hysterectomy indications after molar abortion among patients with risk factors of choriocarcinoma.