ABSTRACT
Malaria still represents a great cause of death in sub-Saharan African areas, mainly among pregnant women. We conducted this prospective study during two years in a malaria-endemic stable region in the east of Madagascar (Toamasina) with an aim to compare the efficacy of weekly chloroquine (CQ) and the use of intermittent presumptive treatment by sulfadoxine-pyrimethamine (SP). 519 pregnant women were included in this study (CQ = 285; SP = 256). Socio-demographical characteristics of each group were identical. We found more peripheral parasitemia (CQ = 8.07% vs SP = 2.73%; P = 0.0068) and severe malaria in the CQ group (CQ = 1.75% vs SP = 0%; P = 0.0332). Anemia was more frequent in the CQ group (CQ = 4.21% vs SP = 0.35%; P = 0.0038). Placental infestation rate was also higher in the CQ group (CQ = 7.01% vs SP = 0.39%; P = 0.00001). Low birth weight and fetal death were lower in the SP group respectively [(CQ = 4.21% vs SP = 0.78%; P = 0.0121) and (CQ = 1.75%vs SP = 0%; P = 0.0332)].
Subject(s)
Antimalarials/administration & dosage , Chloroquine/administration & dosage , Malaria/prevention & control , Pregnancy Complications, Infectious/prevention & control , Pyrimethamine/administration & dosage , Sulfadoxine/administration & dosage , Adolescent , Adult , Drug Combinations , Endemic Diseases , Female , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical/prevention & control , Madagascar/epidemiology , Malaria/epidemiology , Malaria/transmission , Pregnancy , Pregnancy Complications, Infectious/parasitology , Prospective StudiesSubject(s)
Abnormalities, Multiple/diagnosis , Fetus , Intestinal Obstruction/etiology , Pregnancy, Ectopic/diagnosis , Abnormalities, Multiple/pathology , Abnormalities, Multiple/surgery , Acute Disease , Calcinosis/complications , Calcinosis/diagnosis , Calcinosis/pathology , Calcinosis/surgery , Female , Fetal Diseases/diagnosis , Fetal Diseases/pathology , Fetal Diseases/surgery , Fetus/pathology , Humans , Intestinal Obstruction/diagnosis , Intestinal Obstruction/pathology , Intestinal Obstruction/surgery , Madagascar , Male , Middle Aged , Pregnancy , Pregnancy Complications/diagnosis , Pregnancy Complications/pathology , Pregnancy Complications/surgery , Pregnancy, Ectopic/pathology , Pregnancy, Ectopic/surgery , Time FactorsABSTRACT
Objectif: Decrire les facteurs de risque; les indications; les types d'hysterectomie realises et leurs complications rencontrees. Methodes: Il s'agit d'une etude retrospective des hysterectomies obstetricales realisees dans le service de Maternite du Centre Hospitalier Universitaire de Toamasina sur une periode de cinq ans; du 1er janvier 2005 au 31 decembre 2009. Resultats: Vingt-six cas d'hysterectomie obstetricale ont ete realises sur un nombre total de 13978 accouchements soit une frequence de 0;19. Les femmes les plus a risque etaient surtout celles agees entre 20 et 35ans (Odds Ratio = 12;27 ; IC a 95= 2;91 - 51;76; p=0;001) et les grandes multipares (Odds Ratio = 8;94 ; IC a 95= 2;14 - 37;32 ; p=0;001). La presence de suivi prenatal etait associee a un risque moindre (Odds Ratio = 0;2 ; IC a 95= 0;06 - 0;65 ; p=0; 01). L'indication etait dominee par les ruptures uterines (69) et les hemorragies de la delivrance (19). Une hysterectomie subtotale interannexielle a ete realise dans 81des cas. Les complications etaient surtout l'etat de choc (73); les infections (19); et les fistules vesico-vaginales (11;5). Le taux de mortalite maternel et foetal etait eleves; respectivement de 7;69et 81. Conclusion: Une meilleure prise en charge de la grossesse et de l'accouchement permettra de reduire les indications de l'hysterectomie obstetricale. D'autres techniques chirurgicales alternatives meritent d'etre largement diffusees
Subject(s)
Delivery, Obstetric , Hysterectomy, Vaginal , Postpartum Hemorrhage , Uterine RuptureABSTRACT
Un homme de 48 ans etait admis en chirurgie au Centre Hospitalier Universitaire de Toamasina pour une epigastralgie brutale et un syndrome occlusif haut evoluant depuis 72 heures. La radiographie de l'abdomen sans preparation montrait l'image d`une double poche a air gastrique. L'intervention chirurgicale realisee en urgence avait retrouve un estomac violace volvule en organo-axial et des adherences hepato-duodenales. Ces adherences pourraient etre les facteurs favorisants pour ce cas. Une detorsion chirurgicale etait pratiquee amenant une evolution favorable rapide
