[The histological aspect of the uterine vein wall according to age and parity]. / Effets de l'age et de la grossesse sur les veines uterines de la femme Senegalaise.

Veinous pathology is increasingly involved in numerous gynecological and obstetrical conditions. This study describes the histological aspects of uterine vein wall according to age and parity. Uterine vein were taken during autopsy of 50 black women of various age and parity. Necroscopic samples of uterine veins were taken from 50 black women of various and diverse age and parity. Microscopic stains were used to assess histological modifications of veinous walls according to age and parity. The disorganization of elastic fibers, collagen fibers of the media, the muscular wall and elastic fibers of the adventice increased with age. The main histological modifications associated with increasing parity were the increase of collagen tissue and the disorganization of the veinous wall. This study provides useful information for other studies regarding the histological analysis of pelvic veins removed during caesarian section for vascular pathology such eclampsia, abruption.

[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.

[Not Available].

Objectives To study maternal morbidity related to abruptiio placentae (HRP) and its management during delivery. Methodology It was a retrospective study held during one year in the Obstetrics and Gynecology Clinic at the University Teaching Hospital le Dantec of Dakar. From the 69 records of patients who had been faced abruptio placentae, the sociodemograhical and clinical characteristics were studied as well as the treatment applied Results The mean age of the patients was 28.82_+ 6.63 years and the mean parity was 4 _+3 children. At all, 59.4% of the patients were received in emergency care coming from the suburbs and 28.8% had done 3 prenatal consultations. Hypertension prior to pregnancy was seen in 17.1% cases and 20% of the patients presented toxemia. Caesarean section was performed in 11.6% and 88.4% of the patients had vagina delivery. Maternal morbidity was mainly related to haemorrhage and anaemia in 83.3%. Blood transfusion was performed in 56.62%. One hysterectomy due to haemorrhage was done and one patient had hemodialyse for kidney weakness. Lethality linked to abruptiio placentae was 8 maternal deaths leading to o proportion of 11.5%. The leading causes of death were haemorrhage (5 cases) and coagulopathy (3 cases). Conclusion Abruptio placentae is an obstetrical pathology which compromises maternal and foetal prognosis. Appropriate therapies of which caesarean section even if foetal death is diagnosed could improve the prognosis.

[Norplant contraceptive implant]. / Les implants contraceptifs Norplant: évaluation des effects secondaires, du poids et de la tension artérielle dans les cliniques de planification familiale à Dakar (Sénégal).

OBJECTIVE: Norplant is a long lasting contraceptive method which protect again pregnancy for five years. We studied the side effects and the variations related to weight and blood pressure. MATERIAL AND METHODS: The study was carried out in three family planning clinics in Dakar with 450 women who have had their implants for at least six months. Data collection was based on patient interviews and review of medical files. RESULTS: The side effects reported were mainly menstrual problems with 54.7% of the women reporting menstrual spotting. The other non-menstruel side effects were headaches (64.2%) and dizziness (59.1%). The side effects at the insertion site were pruritus (16%) and pain (3.1%). Regarding weight and blood pressure, an increase in weight was observed up to three years of Norplant use and a decrease to the initial weight was seen during the fifth year of use. No variation was noted regarding blood pressure. CONCLUSION: Norplant is a contraceptive method widely used in Senegal. Most of the side effects involve menstrual problems. A slight increase of weight was observed in general with no variation in blood pressure.

[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.

[Comparison of two cesarean techniques: classic versus Misgav Ladach cesarean]. / Comparaison de deux techniques de césarienne: césarienne classique versus césarienne Misgav Ladach.

OBJECTIVE: The aim of the study was to compare two cesarean section techniques Methodology. A prospective study was conducted UB 400 cesareans performed at the Gynecological and Obstetric Clinic of the Dakar Teaching Hospital between March 2000 and August 2000. Two hundred patients underwent the classical procedure (CL group) and the other 200 the Misgav Ladach procedure (ML group). Per- and post-operative data were compared between the two groups with Student's test and the Chi(2) test. A p-value less than 0.05 was considered statistically significant. RESULTS: The two groups were similar for socio-demographic and clinical data. The delay between the skin incision and infant delivery was significantly shorter in the ML group (5 minutes 26 seconds versus 6 minutes 20 seconds). The same trend was found for the length of operation (36 minutes 36 seconds versus 54 minutes 38 seconds). Fewer sutures were used in the ML group (2.92 versus 4.14). There is no significant difference for dose of analgesia, post-operative complications and hospital discharge. Cost analysis demonstrated that the Misgav Ladach procedure was 10000 FCFA (15 euros) less costly. CONCLUSION: Misgav Ladach method is simple, rapid, cost-effective cesarean procedure which appears to be an attractive alternative to traditional cesarean section.

[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.

[Use of the male condom at schools and universities: survey with 1065 young people]. / Utilisation du condom masculin en milieu scolaire et estudiantin: à propos d'une enquete portant sur 1065 jeunes.

From February 25th to June 28th of 1999, the authors carried out a prospective and descriptive study of the use of the preventive male condom in schools and universities through an anonymous inquiry questionary dealing with 1065 persons involving 650 boy students, 181 girl students, 128 college boys and 106 college girls. The questionnary involved 5 headings: the socio-demographic characteristics, the use of condoms, the sources of information and supply, the number of partners, and information about the prices. The inquiry essentially let out that: 56.4% of target population used the male condom. Boys used condoms more often than girls. Most of the boys who used condoms were unmarried. Young people used condoms for preventive purpose against STD/AIDS and for contraception in 82.5 cases. The reason more oftenly given by those who didn't like condoms was the reduction of the sexual delight. The mature age and highest level of instruction were factors predicting the use of condoms. About 2/3 of the information sources on condoms were from media. The drugstore was the main source of supply. More than half of the users wished an extension of the Condom commercialization. The problems of acceptability and access to condoms related more of religions and socio-cultural order than geographical and financial.

[3 cases of vulvar epidermal cysts after female genital mutilation]. / Trois cas de kystes épidermiques de la vulve après mutilations génitales féminines.

We report three cases of tumors of the vulva following an excision during childhood, in patients aged 22 to 25. The achieved surgical removal gave correct aesthetic and functional results. Histological examination of these tumors revealed epidermal cyst containing keratin. Because of clinical, psychological and social impact of female excision, steps should be taken against such traditional practices.

[Tolerance and acceptability of Norplant contraceptive devices]. / Tolérance et acceptabilité des implants contraceptifs Norplant: expérience au CHU A. Le Dantec de Dakar (Sénégal).

OBJECTIVES: Norplant implants have been used for long-lasting contraception in Senegal since 1986. The purpose of this work was to assess tolerance and acceptability of the method among Senegalese women. MATERIAL AND METHODS: A prospective non-comparative study including 300 women was undertaken in the Obstetrics and Gynecology Clinic at the University Teaching Hospital A Le Dantec of Dakar between December 1986 and July 1991. Women meeting inclusion criteria were seen at 1 month, 3 months, and 6 months after insertion then every 6-month until device removal. RESULTS: The mean age of women was 31.3+/-5.45 years and mean parity was 4.7+/-2.45. Almost half of the women no longer desired pregnancy and 67.6% of the women who had not used contraceptive method the month before admission decided to use Norplant. During follow-up visits, 45.2% had menstrual side effects mainly amenorrhea 23.4% and irregular bleeding 12.5%. Non-menstrual side effects were local reactions at the implant site (19.9%). The other side effects were dizziness, asthenia, insomnia, anemia, and high blood pressure and weight change. Overall, 58.8% of the women kept their implants and had them removed after 5 years of use. The failure rate was 3.3+/-1.25. At the end of five years of use, satisfaction was 84.8% and nearly two-thirds of the women decided to recommend Norplant to a friend or relative or to use it again. CONCLUSION: Norplant is a method of choice among the range of contraceptive methods available in Senegal. Because of its advantages and its ease of use, Norplant could be a widely used method in Senegal.

[Uterine rupture in Senegal. Epidemiology and quality of management]. / Rupture utérine au Sénégal. Epidémiologie et qualité de la prise en charge.

The purpose of this prospective longitudinal study was to analyze data concerning patients treated for uterine rupture at surgical maternity hospitals in Senegal between January 1 to December 31, 1996. A total of 50 cases of uterine ruptures were recorded during the study period, i.e., 1 rupture for every 45 cesarian sections. Typical epidemiological features were rural residence (68%), age over 30 years (66%), multiparity (64%), and presence of obstetrical risks factors (76%). In 96% of cases, rupture usually occurred after failure or natural delivery assisted by personnel with limited skills in non-surgical facilities. Treatment consisted of uterine suture in 22% of cases and obstetrical hysterectomy in 78%. As a result of poor facilities for emergency transportation (68% of cases), mean delay between the indication for operative treatment and intervention was 11 hours. Maternal mortality and morbidity were 16% and 14% respectively. Neonatal mortality was 95%. The incidence of uterine rupture could be lowered by improving emergency obstetrical care and identifying risk factors for dystocia during prenatal examinations.

[Neonatal bacterial infections at the CUH of Dakar]. / Infections bactériennes néonatales au CHU de Dakar.

OBJECTIVES: It's a retrospective study in order to determine the epidemiology of neonatal bacterial infection and to evaluate the efficiency of the antibiotic protocol in University Teaching Hospital in Dakar. MATERIAL AND METHODES: From January 1st 1997 to December 31st 1998 we have registered 7461 live births, samples of blood are taken from 2312 new-born baby and they received antibiotherapy (beta-lactamine + gentamycin) at the first day based on infections risk evaluated by anamnestic criterias. The treatment is seven to one days long, the antibiotic was adapted according to the antibiogram result. RESULTS: The neonatal infection diagnosis is confirmed in 246 cases, about 33 per 1000 live births or 10.6% of newborn babies having on antibiotherapy. Most current risk factors are premature rupture of membranes (85%) and neonatal suffering (87.8%). Isolated gerras are: Klebsiella pneumoniae (61.5%), Enterobacteria (11.5 Staphylococcus (8.7%), colibacille (6%), Streptococcus (5.5%), Enterococcus (4.1%) and Pseudomonas (2.7%). Most of these germs are resistant to antibiotics currently used in first intention (ampicillin, cefotaxim, gentamycin), in particularly 95% of Klebsiella. Most efficient antibiotics are amikacin, colistin, ceftriaxon and ciprofloxacine. Deaths occurs in 48 cases with 36 in early neonatal period, 79% of mortality rate related to infection by Klebsiella. CONCLUSION: First intention antibiotherapy must be always adapted to the bacterial ecology evolution and must be more selective by using major infections risk factors. We promote early infection diagnosis by using biologic markers which reference is represented by C Reactive Protein.

Complications of induced abortion and miscarriage in three African countries: a hospital-based study among WHO collaborating centers.

OBJECTIVE: The aim of this study was to describe two of the outcomes of pregnancy, induced abortion and miscarriage, in three African countries. Major maternal risk factors were also evaluated. METHODS: The study was prospective and based on the medical files of all 1,957 women admitted to participating health care structures. RESULTS: Overall, 988 women were admitted for complications of miscarriage, and 969 for complications of induced abortion. Gestational age was lower in women with miscarriages (p<0.002). The level of use of contraceptive methods ((p<0.003) and educational level ((p<0.005) were lower in women who had had an induced abortion. In our study, 26 maternal deaths were recorded, 22 of which were associated with induced abortion. Infection was the most important risk factor for death (OR=4.8; 1.9-12.4). CONCLUSION: Maternal deaths related to abortion complications often occurred shortly after hospital admission and with signs of sepsis. This demonstrates the importance of effective emergency services. Unfortunately, hospital-based studies alone cannot assess all maternal death risk factors, especially those for maternal death related to induced abortion complications. It is therefore important to determine what happened to the woman before hospital admission and during her stay in hospital. Combinations of qualitative and quantitative methods could be used to increase our understanding of this problem and to help us to solve it.

In vitro production of immunoglobulins of various classes and subclasses by cord blood B cells in African neonates: modeling and assessment of determination.

Cord blood B cells obtained from neonates of healthy Senegalese mothers were assayed in vitro for their capacity to fully differentiate and secrete immunoglobulins (Ig) of various classes and subclasses. Stimulation of mononuclear cells with SAC particles or anti-micro antibodies in the presence of IL-4, or with IL-2 and IL-10 induced a strong production of IgG, provided that an additional CD40/CD40L signal was present, in contrast to adult cell cultures. Cord blood mononuclear cells differentially stimulated with various cytokines in order to lead to Ig heavy chain switching and production of the various classes/subclasses consistently produced IgG1, IgG3, IgG4, IgE and IgA. This system has been applied to immune cells from African neonates that have not been extensively studied previously. Estimation of Ig production as OD ratios could be applied to cultures where cord blood B cells are stimulated with defined antigens of human pathogens to which the fetus immune system was primed in utero.

[Uterine rupture in Senegal. Results of 2 surveys taken in 1992 and 1996]. / Ruptures utérines au Sénégal. Résultats de deux enquêtes effectuées en 1992 et 1996.

OBJECTIVES: National prospective descriptive study on dystocia were conducted in Senegal in 1992 and 1996. We examined more closely the data on uterine rupture to determine trends between these two surveys. METHODS: Data were collected for all patients undergoing an obstetrical intervention between January 1st and December 31st in 1992 and in 1996 in one of the referral maternity-obstetrical surgery units in each of the 10 regions in Senegal. RESULTS: The rate of uterine rupture was 1 per 51 interventions in 1992 (1.87%) versus 1 per 53 interventions in 1996 (1.94%). This dramatic event was recurrent in 7 of the 10 regions. The patients involved were aged 25-35 years (68% in 1992 versus 70% in 1996), multiparous or grand multiparous (52% in 1992 versus 70% in 1996), illiterate (90%), with poor follow-up (less than 3 prenatal consultations in 56% of the cases), and were generally evacuated to the unit (80% in 1992 versus 97% in 1996) without medical care (55%). Maternal mortality was high (28% in 1992 versus 12% in 1996). Infant mortality was also very high (98% in 1992 versus 86.6% in 1996). Conservative treatment of uterine rupture was used increasingly: the rate of conservative suture rose from 3.3% in 1992 to 22% in 1996. CONCLUSION: Prevention is a challenge for healthcare workers, public authorities and the population in general. Health policy should be directed towards forming general practitioners in obstetrical surgery. Emergency surgery kits should be made available to improve the quality of care in all maternity units throughout the country.

[Peripartum idiopathic myocardiopathy: prospective echocardiographic study]. / La myocardiopathie idiopathique du péripartum: étude prospective échocardiographique.

Still frequent in Africa, the idiopathic peripartum cardiomyopathy (PPC) is the subject of only few prospective studies. The aim of this prospective work was to assess the echocardiographic abnormalities of the PPC and to determine on 26 patients the evolution and the prognostic factors of this disease. Six women had mild to moderate pericardial effusion. The abnormalities of the wall motion, constantly found, were diffuse in 20 cases (77.1%) and localized or prevalent on the interventricular septum or the left ventricular posterior wall in the other cases. The cardiac chambers were dilated in 24 cases (92.3%). Left ventricular hypertrophy was noted among 16 patients (61.5%); it was eccentric in 15 cases. The left ventricular systolic dysfunction was constant. The other abnormalities were: the abnormal left ventricular relaxation (one case), low mitral and aortic flow (12 cases), the mitral (21 cases) and tricuspid regurgitation (five cases). One noted a septal hypertrophy and an isolated dilatation of the right ventricle. The mean follow-up was 7.3 +/- 1 month (1-18 months). Two patients died at the 4th and 8th month. Among the 24 survivors, 11 had normalized were: the gestity (p = 0.01), the parity (p = 0.01), the cardiothoracic ratio (p = 0.04), the left ventricular volumes (p = 0.02), and the parameters of left ventricular function. The echocardiography of patients with PPC usually shows a pattern of dilated and hypokinetic cardiomyopathy, but many variations are possible. Most of the patients keep echocardiographic abnormalities after mean term follow-up.

[Maternal risk factors and low birth weight in Senegalese teenagers: the example of a hospital centre in Dakar]. / Facteurs de resques maternels et petit poids du nourveau-né chez des adolescentes sénégalaises: l'exempl d'un centre hospitalier de Dakar.

AIMS OF THE STUDY: a) to identify the risk factors associated with newborn babies' low birth weight in teenage mothers; b) to propose prevention strategies for lower-ing neonatal morbidity and mortality. SPHERE OF THE STUDY: the study was carried out at the maternity and neonatology service of the Abass Ndao hospital centre, a urban community hospital located in the Southern part of Dakar. MATIERIAL AND METHODS: this retrospective study was carried out between July 1, 1998 and June 31, 1999. All new mothers under 20 who had given birth to living newborn babies have been included in the study and categorised into two groups, according to their babies' birth weight: 1) a first group of teenagers whose newborn babies' birth weight was lower than 2,500 g (low birth weight); 2) a second group constituted of women whose newborn babies' birth weight was higher than 2,500 g, and which was used as a control. The socio-demographic, biometrics, maternal and obstetric factors have been analysed and compared. RESULTS: out of the 4,586 women in childbirth during the study period, 456 were under 20 years of age, which corresponds to a prevalence rate of 10%. One hundred and five women had newborns weighing less than 2,500 g, which corresponds to a prevalence rate of 23%. Certain factors were found to be significantly associated with low birth weight: low weight gain during pregnancy (p = 0.04), fewer antenatal consultations (0.006), and kidney-related syndromes during pregnancy (0.0005). CONCLUSION: The results of that study allow us to recommend the following strategies: - control and improvement of nutritional behaviour during pregnancy; campaigning for a better attendance at antenatal consultation services for the early detection of pathologies during pregnancy and for preventing kidney-related syndromes.

[Prevention of infection in a surgical environment in the regional hospitals of Senegal]. / Prévention de l'infection en milieu chirurgical dans les hôpitaux régionaux de Sénégal.

This study evaluated the attitudes and practices of the personnel with respect to the prevention of nosocomial infections in a hospital environment. We carried out a qualitative survey of all categories of personnel between July 1998 and March 1999, at the five regional hospitals in Senegal (Thiés, Kaolack, Saint-Louis, Diourbel, and Louga). Data were collected in two ways: using a questionnaire to evaluate knowledge and by observing the attitudes and practices of the personnel. Hands were rarely washed before and after each procedure and surgical washing was often performed in poor conditions. The decontamination of soiled equipment was ineffective. Reusable instruments were washed directly with bare hands or by individuals wearing used surgical gloves. The equipment used for sterilization was dilapidated and unsuitable and the norms for sterilization were seldom respected. Circulation in the region of the operating theatre was disorganized, if not anarchic. The personnel had a high risk of contamination from blood. Biomedical waste was not decontaminated: it was collected poorly and disposed of directly into the environment. None of the sites visited had a program of waste incineration. In conclusion, at the sites visited, there is a high risk of nosocomial contamination during care and the reuse of equipment, for both the staff and the patients treated.

[Giant ovarian cyst and pregnancy (a case report)]. / Kyste géant de l'ovaire et grossesse (à propos d'un cas).

We report a case of giant ovarian cyst in pregnancy of 23 weeks of amenorrhea revealed by digestive and respiratory compression. As the absence of ultrasonographic and biologic malignancy criterias, several punctures of the cyst were done permitting the evolution of pregnancy until the preterm period. An annexectomy done in the immediate post-partum permitted to avoid the frequent mechanical accidents during this period. From this case, we discuss clinical and therapeutic problems of this association.