La problematique des parturientes evacuees en zone rurale senegalaise : exemple du centre hospitalier de Ndioum

Objectifs : Decrire les difficultes rencontrees par les parturientes evacuees dans une zone rurale au Senegal. Methodologie : Etude prospective sur une periode de 12 mois allant de janvier a decembre 2011. Toutes les patientes evacuees vers la maternite. Resultats :La frequence des evacuations obstetricales etait de 31;2. Le nombre moyen de consultation prenatale etait de deux. Une femme sur 3 avait effectue plus de 4CPN (33;3). La grossesse etait a terme dans 83;6 des cas. La distance parcourue etait en moyenne de 48 Km avec des extremes de 1 a 200 km. L'evacuation etait faite au moyen d'une ambulance dans 69 des cas et celle-ci etait accompagnee par un prestataire non qualifie dans 92;7 des cas. La patiente etait vivante bien portante dans 98 des cas. L'enfant etait ne vivant bien portant dans 75;4. La duree de sejour moyenne etait de 2;6 jours avec des extremes de 1 et 12 jours. La contre-reference etait effectuee dans 97;3 des cas. Conclusion : Les resultats de notre etude nous permettent de confirmer malgre les ressources limitees; il est possible de prendre en charge et de reduire la morbidite et la mortalite des patientes evacuees. En effet nous preconisons de mettre en place un systeme de SAMU obstetrical en zone rurale afin de contribuer a la regulation des evacuations obstetricales; mais surtout de permettre aux patientes a faible revenu d'acceder au service

[Periodontal status in a sample of Senegalese women using hormonal contraception]. / Etat parodontal d'une population de femmes Sénégalaises sous contraception hormonale.

Hormonal contraception is based on the use of synthetic hormones containing variable doses of oestrogen and progesterone making it possible to avoid pregnancy in a temporary and reversible way. The objective of this study is to evaluate the periodontal status of a sample of Senegalese women under hormonal contraceptive. One hundred women using contraception since at least 6 month were paired on the age, the socio-economic profile and oral hygiene with a control group. Oral hygiene (plaque index (PI) of Silness and Löe), the inflammation (gingival index (GI) of Löe and Silness), probing depth and clinical attachment loss were recorded. With equal hygiene, the scores of the gingival index were significantly higher among women under contraceptive (p < 0.001). Inflammation was significantly more marked for the women who used contraception in injectable form compared to the control group (p < 0.001). Probing depth (3.01 +/- 0.04) and clinical attachment loss (3.19 +/- 0.08) were significantly more important among women under contraceptive (p < 0.001). The women under contraceptive seem to set up a group at risk for developing a periodontal disease, it is thus necessary to systematise periodontal appraisal before and during contraceptive use period.

[Prognosis of uterine rupture during labor: a 293-case series compiled at the Bouake University Hospital Center (Ivory Coast)]. / Pronostic de la rupture utérine au cours du travail: à propos de 293 cas colligés au CHU de Bouaké (Côte d'Ivoire).

The purpose of this retrospective comparative study carried out between January 1, 1996 and December 31, 2001 was to determine the incidence of uterine rupture in the maternity ward of the Bouake University Hospital Center and evaluate prognosis for the mother and child in function of transportation distance to the Center. Patients were divided into two groups, i.e., patients transported from an arbitrarily defined safety zone within a 100-kilometer radius of the city and patients from outlying areas beyond the safety zone. The overall incidence of uterine rupture was 2.44%, i.e., one of 41 deliveries. Hysterectomy was performed more often in women from outlying areas: 83.34 % versus 28.57% (p = 0.0000). Mortality secondary to uterine rupture was 411.26% overall with a higher rate in patients from outlying areas than patients from the safety zone: 29.91% versus 8.97% respectively (p = 0.0052). Fetal mortality was 100% for patients from outlying areas. The prognosis of uterine rupture is less favorable for both the mother and child in patients transported from outlying areas.

Pronostic de la rupture utérine au cours du travail : à propos de 293 cas colligés au CHU de Bouaké (Cote d'Ivoire)

L'objectif a été de préciser la fréquence de la rupture utérine au sein de la maternité du CHU de Bouaké et de déterminer le pronostic en fonction de l'éloignement du CHU de Bouaké. Il s'agit d'une étude rétrospective et comparat ive qui s'est déroulée du 1er janvier 1996 au 31 décembre 2001. Cette étude a comparé les caractéristiques et le pronostic materno-fœtal de deux types de patientes : celles issues d'un périmètre de sécurité sanitaire arbitraire défini de 100 kilomètres autour de la ville et celles issues de localités situées au-delà. La fréquence de la rupture utérine a été de 2,44 % soit une rupture utérine pour 41 accouchements. L'hystérectomie a été plus pratiquée dans la population des femmes issues de localités situées au-delà du p é ri m è t re de sécurité sanitaire : 83,34 % contre 28,57 % (p < 10- 4). La létalité de la ru p t u re utérine a été de 11,26 % pour l'ensemble des patientes avec une surmortalité pour celles venues de localités au-delà du périmètre de sécurité sanitaire : 29,91% c o n t re 8,97 % pour celles du péri m è t re de sécurité sanitaire (p = 0,0052). La mortalité fœtale a été de 100 % pour les patientes hors du périmètre de sécurité sanitaire. Les patientes présentant une rupture utérine et évacuées de localités situées au-delà du périmètre sécurité sanitaire ont un pronostic materno-fœtal beaucoup plus sombre

[Sonographic features of gestational choriocarcinoma]. / Aspects echographiques du choriocarcinome gestationnel. Résultats préliminaires a propos 13 cas.

PURPOSE: To describe the sonographic morphological features of gestational choriocarcinoma. MATERIALS AND METHODS: Retrospective evaluation of 13 cases of gestational choriocarcinoma diagnosed by clinical and laboratory (BHCG) criteria in all cases and confirmed by histological data in 8 cases. RESULTS: The tumor presented multiple features (nodular, submucosal, macrocystic, multicystic, compact and microcystic) often with involvement of surrounding tissues. All cases showed myometrial involvement. The size of the ovaries was normal with small corpus luteum cysts noted in only 5 cases. In 2 cases, ultrasound modified the clinical staging. CONCLUSION: Sonographic features of gestational choriocarcinoma are variable, and may mimic other diseases of the endometrium or myometrium. The involvement of multiple layers of the uterus suggests a malignant disease.

[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.

[Fertility after ectopic pregnancy at the University Hospital in Dakar]. / Fertilité après grossesse extra-utérine au CHU de Dakar.

The aims is to evaluate fertility and medical cost about post ectopic pregnancy follow up. It is about a retrospective and descriptive study about 337 patients who have the opportunity to get a salpingectomy for an ectopic pregnancy between 1989 and 1997 at Le Dantec Gynecological and Obstetrical Clinic. After the ectopic pregnancy cure, women are followed with contraception, just time before trying to obtain another pregnancy. The studied parameters are: age, parity, socio-economical status, level of instruction, obstetrical and gynecological antecedents, Chlamydia serology, hysterosaipingography data, fertility after ectopic pregnancy, fees related to the cost of follow up after ectopic pregnancy. Data exploitation is done through an epidemiologic programme named Epi Info version 5 The average age of the patients was 27 years and that of the parity was 2.70. 87.83% of women were married. More than the half of those patients came from the suburb of Dakar. 171 patients (50.74%) were followed regularly, the other 166 (49.26%) disappeared. A Chlamydia trachomatis infection was found among 23.4% of cases. A tubal obstruction was noted in the level of the horns at 12.5 % of women. No case of maternal death was observed. Among 59 patients who wished a pregnancy, 34 ectopic pregnancy had been obtained (57.62%) in 4 month after stopping contraception and 26 cases of a new ectopic pregnancy. The expenses of medical cure after ectopic pregnancy are about 17.814 to 71,574.65 F CFA with an average of 38,689 F CFA (389.89 FF). Medical care after ectopic pregnancy raises a lot of problems: --some patients disappeared probably because of the inaccessibility of financial cost, --the high rate of Chlamydial trachomatis infection, an hypofertility after ectopic pregnancy. To combat this, we have to insist in the prevention of sexually transmitted diseases in general and of the chlamydial infection in particular. We have also to insist in the early diagnosis of the ectopic pregnancy. At last, we must set up a registre of ectopic pregnancy at the national level.

[Breast cancer and pregnancy: about 60 cases collected at the Cancer Institut of Dakar]. / Cancer du sein et grossesse: à propos de 60 cas colligés a l'Institut du Cancer de Dakar.

The purpose of this retrospective study of 60 breast carcinoma during pregnancy collected at the Cancer Institut of Dakar from 1962 to 1998 was to determine the epidemiology, the clinical appearance and to discuss the pathogeny, the diagnosis, the prognosis and the treatment. The mean of age of patients was 34.5 years. The number of parity was 5 and the first pregnancy at 20 years. The authors arrived at diagnosis in the post partum in 28 cases (47.45%), in the first trimester in 8 cases (13.55%), in the midtrimester in 13 cases (22.03%) and in the third trimester in 11 cases (18.64%). The polychemotherapy preceded the surgery in 30 cases and succeded in 16 cases. The hormonotherapy with Tamoxifen prescribed in 17 cases after the delivery. The mastectomy and axillary lymphadenectomy was realised in 26 cases in the post partum. The adjuvant radiotherapy was done in 12 cases. The mortality was 31% and the global survival at 2 years, 34.6%.

[Uterine perforation after an illegal abortion]. / Perforation utérine après avortement provoqué.

This study focuses on problems related to the management of peritonitis following non-medically assisted abortions in developing countries. Between January 1, 1997 and December 31, 1998, four cases of peritonitis due to perforation of the uterus occurred in a consecutive series of 101 women treated following non-medically assisted abortions at the Gynecology and Obstetrics Clinic of the University Hospital Center in Dakar, Senegal. Abortions were performed by untrained persons using dangerous instruments (wood or metal probes) for prices ranging from 5000 to 30,000 CFA francs. The mean interval between abortion and hospitalization was seven days. All patients presented in poor condition with low-grade symptoms of peritonitis. In 3 of 4 cases, the site of perforation was located in the isthmus (anterior, posterior, and lateral). Extensive necrotic lesions required hysterectomy. Postoperative complications occurred in 3 cases including parietal infection in one case, repeat peritonitis requiring re-operation in one case, and fatal iliomesenteric infarction in one case. Prevention could best be achieved by reducing unwanted pregnancies by better sex education and access to contraceptive techniques.

[Complications of tubal sterilization by minilaparotomy under local anesthesia]. / Complications de la stérilisation tubaire par minilaparotomie sous anesthésie locale.

Between January 1, 1991 and June 30, 1996, physicians performed 800 cases of tubal ligation via minilaparotomy under local anaesthesia in the Obstetrics and Gynecology clinic of the Dakar University Teaching Hospital (Senegal). There were complications in 7 (0.87%) cases (bladder and bowel injuries: 6 cases, and post operative infection: 1 case). The most frequent risk factors were: surgeon skill (lack of experience of surgeon in minilaparotomy), type of patients (obesity, previous abdominal surgery). It was concluded, proper training and experience of the surgical team is needed to minimize sterilization related complications.

PIP: Although only a small percentage of reproductive-aged women in Africa opt for sexual sterilization, it is the most widely used method of family planning worldwide. Most female sterilizations in Africa are performed using minilaparotomy under local anesthesia. While this approach offers benefits, especially when only inadequate equipment is available, it can also result in operation-related consequences. Results are presented from a retrospective study of records on 7 cases involving complications recorded at the Gynecological and Obstetrical Clinic of the University Hospital in Dakar in a series of 800 tubal ligations performed using minilaparotomy under local anesthesia between the beginning of January and the end of June 1996. The complication rate of 0.87% is comparable to that reported in the literature. There were 3 cases of bladder injury, 3 cases of bowel injury, and 1 case of post-operative infection. The injuries, of which the average length was 1.5 cm, were repaired immediately under general anesthesia. The tubal ligation was then performed. Main risk factors for complications were operator inexperience and the poor choice of candidates being obese and having histories of abdominal surgery. Despite the possibility of complications, tubal ligation through minilaparotomy under local anesthesia should be considered simple, safe, and affordable.

[Sexually transmitted diseases and female sterility at the University Hospital Center of Dakar: management and prevention]. / Maladies sexuellement transmissibles et stérilité féminine au CHU de Dakar: prise en charge et moyens de prévention.

It is a retrospective study supporting 82 cases continued series of feminine sterility and which objective is to evaluate the nursing management quality of genital infection in exploration and treatment of sterility. Women mean age is 26 years old, sterility is most primary frequently (68%) and from fallopian origin (80%). Followers examinations have been asked: vaginal taking (100%), urines cytobacteriology examination (56%), syphilis serology (23%), chlamydia serology (57%), mycoplasma serology (03%). Genital infection have been diagnosed in 75% of cases, in 33% of cases positive Chlamydia serology was found. Three molecules have been used principally in treatment: cyclines 50%, imidazoles derived 47%, lactamines 15%. The upper cost of diagnostic and treatments produce a wishest of prevention which based is the tracking and the precocious treatment of STD.