[Factors predicting outcome of trial of labor after prior cesarean section in a developing country]. / Facteurs prédictifs de l'issue d'une épreuve utérine en milieu sous-équipé

OBJECTIVE: To determine factors predictive of the outcome of trial of labor after cesarean section in women living in developing countries. MATERIAL: and methods. A retrospective study of 313 cases of trial of labor was conducted in patients with a history of at least one prior cesarean section. Multiple logistic regression was used to identify predictive factors. The adjusted odds ratios with 95% confidence intervals (95%CI) were used to indicate risk of failure of the trial of labor when the factor was present. RESULTS: The rate of vaginal birth was 71.6%. Factors significantly predictive of failure of trial of labor were birth weight>3000 g (OR=2.68; 95%CI: 1.57-4.57), no previous vaginal delivery (OR=1.71; 95%CI: 1.26-3.76) and maternal age>28 years (OR=1.71; 95%CI: 1.01-2.90). CONCLUSION: Trial of labor should be proposed in most women with one previous cesarean section. A prior history of vaginal delivery is the best predictor of the positive outcome of trial of labor.

[Teenage knowledge about sex]. / Information des jeunes en matière de sexualité.

The aim of this study was to investigate the quality and sources of teenagers' information about sex. Between October 26th and December 16th 1997, 277 pupils from lower and upper schools agreed to participate in this study. Two hundred and seventy (97.5%) of the pupils in this population declared that they had received information about sex. This information was provided principally by the media, followed by friends, boyfriends and girlfriends, the school and their parents. The information received concerned sexually transmitted diseases (STDs and AIDS), the consequences of sexual relationships, sexual hygiene and the signs of puberty. We found that 95.5% of the pupils knew about AIDS and gonorrhea and that 91.7% knew how to protect themselves against AIDS and STDs. Thus, most pupils had received information, from various sources, on sexuality. Parents played little role in the sexual education of their children, and the State was involved in various ways.

[Use of the ROC (receiver operating characteristic) curve in the prediction of fetal hypotrophy with uterine height measurement]. / Utilisation de la courbe ROC (receiver operating characteristic) dans la prédiction de l'hypotrophie foetale par la mesure de la hauteur utérine.

OBJECTIVE: To determine the cut-off point of the uterine height (UH) to predict hypotrophy using ROC curve. MATERIAL AND METHODS: This study was conducted in the Departement de Gynécologie-Obstétrique du CHU-Tokoin. It included 883 pregnant women; delivrance issued in an unique fetus in longitudinal position. Studied variables were UH in the labor room and the birth weight. Children with birth weight less than the 10th percentile were considered to be hypotrophic. An UH value less than the positivity cut-off point was considered positive while a superior value was negative. Performance to predict hypotrophy was expressed in terms of sensitivity, specificity, predictive values. Using ROC curve, we tried to determine the best cut-off point for the UH. RESULTS: In our study, 87 newborn (9.9%) were hypotrophic. UH at 32 cm helps in the best screening of hypotrophy (Sensitivity 70.1%, Specificity 67.2%, PPV 18.9%, NPV 95.4%). CONCLUSION: Hypotrophy can be suspected with a UH less than 32 cm.

[Prediction of fetal hypotrophy by uterine height]. / Prédiction de l'hypotrophie foetale par la hauteur utérine.

OBJECTIVE: To assess the predictive value of uterine height (UH) in the screening of hypotrophy. MATERIAL AND METHODS: UH percentiles curves depending on gestational age were established on a sample of 385 newborns with normal weight. The assessment of predictive value of the UH was done in 430 pregnant women knowing exactly their last menstruation period. Performance of UH to predict hypotrophy was expressed in terms of sensitivity, specificity, predictive values and likelihood ratios with their 95% confidence intervals. RESULTS: Sensitivity of at least 2 measures of the UH less than the 10th percentile was 71.1% with a specificity of 94.8%. Positive and negative predictive values were 61.5% and 96.6% respectively and the likelihood ratios were 13.6 for a positive test and 0.3 for negative test. CONCLUSION: A serial measure of UH can be useful in the screening of hypotrophy especially in our region where the UH remains the only tool to assess the fetal growth.

[Sexual practices in the school milieu]. / Pratique de la sexualité en milieu scolaire.

OBJECTIVE: To appreciate the real sexual practice among students. POPULATION AND METHODS: From 29th April to 10th May 1997, 1,867 students from lower and upper schools have accepted to take part in the investigation being carried on their practice of sexuality. RESULTS: 1,333 students, that is 72% of the group, have already had sexual intercourse. The average age of the very first sexual intercourse was 17 years and the extreme ages range from 8 to 24 years. 72.7% of the students have already had sexual intercourse less once a month, mostly it is by love in 68.6% or by desire in 21.1%. Among more than half of the girl students, that is 59.5%, their partners was students. 31.3% were at least once pregnant. CONCLUSION: The outcome of this study revealed that sexual activity among students is rare and sporadic. It is motivated by love.

Aspects radiologiques de la pathologie utero-tubaire dans la sterilite feminine: a propos de 1314 hysterosalpingographies au CHU-Lome

1314 examens hysterosalpingographiques ont ete realises chez des femmes consultant pour sterilite secondaire et 25 pour cent une sterilite primaire. Les anomalies radiologiques observees sont dominees par les lesions uterines (53 pour cent) dont pres de la moitie representee par les sequelles traumatiques (27 pour cent). Les osbtructions tubaires representent 30 pour cent. 17 pour cent des femmes ont une hysterosalpingographie normale. La proportion elevee des sterilites secondaires; des lesions traumatiques uterines et des obstructions tubaires traduit la necessite de mettre en place des programmes de sante publique visant a sauvegarder la fecondite de la femme bien que les experts demographes parlent de l'Afrique en terme d'explosion demographique et de limitation des naissances

Biometrie ultrasonore et estimation du poids du foetus togolais : a propos de 512 gestantes au C.H.U. de Lome

Les conditions socio-economiques; le facteur racial et la meconnaissance frequente de la date des dernieres regles dans nos milieux ont motive a etablir les courbes biometriques echographiques chez 512 foetus togolais. 1831 mesures biometriques des 6 parametres classiques (LCC; DBP; DOF; CT; CA; LF) ont ete realisees. D'une facon generale; ces courbes sont identiques a celles produites en Europe ou en Amerique avec toutefois des valeurs relativement inferieures; ce qui permet d'etablir un age gestationnel precis. L'estimation du poids foetal a partir des DBP; CA et LF donne des valeurs inferieures aux valeurs europeennes et americaines; mais elles sont superposables avec celles des auteurs africains

Surveillance de la chimioprophylaxie antipaludeenne chez la femme enceinte à Lomé et en milieu rural au Togo

Cette etude nous montre que 28 a 33 pour cent de femmes enceintes en ville et en milieu rural ne suivent aucune chimioprophylaxie. Malgre la chloroquino-resistance; 70 a 83 pour cent de souches sont sensibles a la dose de 5 mg/kg de chloroquine. A la lumiere du taux eleve de non observance de la chimiotherapie par les femmes enceintes en ville et en milieu rural; il convient de revoir la strategie d'information et d'education pour la sante

[Carriage of Streptococcus B in the mother and infant pair at birth. Apropos of 106 cases]. / Portage du streptocoque B dans le couple mère-enfant a la naissance. A propos de 106 cas.

Streptococcus of group B found in the upper respiratory tract, the genito-urinary tract and the intestines of humans and animals is responsible for peri- and neonatal infections with serious outcomes: septicemia, meningitis. In Togo, the high frequency of neo-natal infections brought us to question the importance of streptococcus B in the mother-child couple at birth and to undertake a study conducted simultaneously in two maternities in the city of Lomé. During 8 weeks, from 19 March-19 May we studied 100 mother-child couples and 300 placentas. The following laboratory samples were taken: from the mother a vaginal smear during labor at 5 cm dilatation and rectal swabbing, from the new-born, a swabbing of the outer ear canal and an aspiration of gastric liquid, a fragment of the placenta taken under conditions of surgical asepsis. The results obtained prove that streptococcus B play an important role in the mother-child couple in Togo. The authors propose that more systematic research be conducted on children at birth with regard to this issue.

[Antitetanus immunity in mother-child pairs]. / Etude de l'immunité antitétanique dans le couple mère-enfant.

A study on tetanus toxoid immunity in mothers and their children by passive hemagglutination using "Vacci T Pasteur" was conducted in two stages: an initial study of 100 mothers and their newborns was conducted with no particular selection criteria used. Tetanus toxoid titers were measured on serum directly for the mothers and on whole blood using filter paper for the children; a second study of 100 mothers and children was conducted using defined criteria for enrollment. Blood was drawn directly from the veins of both the mother and child in this study. Titers were measured for both mother and child on serum. In both studies it was verified that the pregnant women has good vaccination coverage. However, the study of immunity levels among the newborns showed different results in the two studies. The authors discuss the reasons for these differences and formulate recommendations for an use of these tests during sero-epidemiologic studies in tropical climates.