Inversion utérine : à propos d'un cas à l'hôpital Général de Loandjili de Pointe-Noire au Congo

L'inversion utérine est un retournement de l'utérus en doigt de gant. Deux éléments essentiels conditionnent la survenue d'une inversion utérine : une atonie utérine et une dilatation cervicale avancée. A ces deux éléments peut s'ajouter une attitude obstétricale inadaptée. Le diagnostic de l'inversion est clinique. Celui-ci est évident lorsqu'il s'agit d'un stade avancé de l'anomalie (stades III et IV). Par contre, l'inversion utérine de stade précoce (stades I et II) peut passer inaperçue, et ne se révéler que par les complications. En effet, les complications les plus redoutables sont l'hémorragie de la délivrance et l'infection puerpérale.La réduction manuelle de l'inversion utérine est possible lorsqu'elle est découverte précocement, et la chirurgie n'est réservée qu'en cas d'échec de tentative manuelle.Le but de cette observation est de préciser les difficultés diagnostiques, ainsi que les particularités de la prise en charge de l'inversion utérine. Nous rapportons l'observation d'une patiente de 36 ans, quatrième geste, troisième pare, avec un antécédent d'interruption volontaire de grossesse ; admise dans le service pour hémorragie génitale persistante au sixième jour du post partum, dans un contexte d'inversion utérine associée à un placenta accreta.La prise en charge a été chirurgicale et faite d'une hystérectomie

Paludisme congenital au centre hospitalier et universitaire de Brazzaville : une etude epidemiologique de 90 cas

OBJECTIFS. Determiner la prevalence et le profil epidemiologique des meres paludeennes et identifier les formes cliniques de paludisme congenital sevissant au CHU de Brazzaville. MeTHODES. Il s'agit d'une etude prospective; de type longitudinal; chez les nouveau- nes de meres paludeennes; ayant presente une temperature superieure ou egale a 380 C ; excluant les nouveau-nes avec excoriation cutanee et ceux dont le cordon a ete traite. Les variables suivantes ont ete analysees : prevalence; parite; nombre de consultations prenatales; prophylaxie palustre; niveau socio-economique des meres. Le texte de Chi 2 de Pearson a ete utilise pour la comparaison des pourcentages. ReSULTATS. L'age moyen etait de 22 ans (extremes : 15-39 ans) ; sur 610 nouveau-nes de meres paludeennes; parmi lesquels 90 cas de paludisme congenital; la frequence du paludisme congenital infection est de 0;64% des accouchements du service ; et 30% des meres paludeennes. Aucun cas de paludisme congenital maladie n'a ete retrouve. Le profil epidemiologique des meres transmetteuses de paludisme congenital est : Primipares (70/400 des cas soit 77;8%) ; de bas niveau socio-economique (80/450 soit 88;9%) ; parturiente n'ayant effectue aucune consultation prenatale (60/ 300 soit 66;7%) et ne prenant aucune prophylaxie palustre (75/4I0 soit 83; 3%). CONCLUSION. Le paludisme congenital; bien que rare est une realite a Brazzaville .Des efforts restent a faire dans l'education sanitaire des populations et la generalisation de la prophylaxie palustre chez les gestantes a risque

[Twelve months of colposcopy use at the Brazzaville University Hospital Gynecology Clinic]. / Bilan d'un an de colposcopie à la maternité du CHU de Brazzaville

OBJECTIVE: To assess the utility of a colposcope after 12 months of use at the Brazzaville University Hospital. PATIENTS AND METHODS: This retrospective study took place in the gynecology unit of the Brazzaville University Hospital and reviewed records dating from January 11, 2010, through January 10, 2011. In all, 150 women (13.5% of all gynecology consultations) underwent colposcopies in the department, for one of two indications: diagnostic colposcopy after an abnormal cervical smear, 91 cases (60.7%), and primary colposcopy in women admitted without a cervical smear, 59 cases (39.3%). High-grade squamous intraepithelial lesions (HGILs) were noted in 36.7% of the cases; the colposcopy was normal in 17.3% of the cases, and squamous cell carcinoma was found in 8.6% of the cases. Colposcopy found HGILs on 14 smears of 24 cervical smears reporting low-grade squamous intraepithelial lesions (LGIL), six of seven initially reported as HGIL, and 10 of 20 initially reported as atypical squamous cells of undetermined significance (ASCUS) on 20. In all, 93 women (62%) had biopsies. Cervical intraepithelial neoplasia 2 (CIN2) lesions were noted on 19 of the 55 biopsies of HGIL colposcopies and CIN3 on four of the 55. DISCUSSION: Colposcopy remains unavailable to too many women, largely because of the difficulty in obtaining a primary cervical smear tests. This also explains the overuse of primary colposcopy or, at least, the uncertainty about its role.

[Unassisted natural childbirth at the Talangai Central Hospital in Brazzaville, Congo]. / Accouchements sans assistance médicale à l'hôpital de base de Talangaï à Brazzaville (Congo).

OBJECTIVES: The purpose of this study was to determine the profile of women who give unassisted natural home childbirth (UNHC) in Brazzaville and to evaluate maternal and perinatal morbidity and mortality. PATIENTS AND METHODS: This prospective descriptive study was carried out at the Maternity Clinic of the Talangaï Central Hospital (TCH) from November 1, 2006 to October 31, 2008. PATIENT SELECTION: Women who gave UNHC and were afterwards admitted to the TCH. RESULTS: The frequency of UNHC was 3.7%. The 19- to 35-year age bracket accounted for 72.6% of cases. The main causes underlying UNHC were ignorance of the initial clinical signs of labor for 37 of the 61 primipares (60.7%) and waiting for onset of labor before going to the hospital for 167 of the 360 paucipares and multipares (46.4%). For 234 women, UNHC occurred after pregnancy without prenatal care. In 57.8% of these cases, the reason for admission after UNCR was hemorrhage. More than half of the women (56.8%) who gave UNHC lived women live near a medical facility. Term pregnancies accounted for 41.3% cases of UNHC and undetermined term for 34.4%. At least one maternal complication was observed in 65.3% of cases. Neonatal morbidity was observed in 24% of cases and perinatal mortality in 11.4%. CONCLUSION: UNHC is still common in Brazzaville owing mainly to poor public awareness. Public information campaigns to educate women to recognize the initial signs of labor could decrease the frequency of UNHC.

[Arterial hypertension: epidemiological aspects and risk factors on pregnant and delivered woman]. / Hypertension artérielle: aspects epidémiologiques et facteurs de risque chez la gestante et l'accouchée.

OBJECTIVES: Determine frequency of hypertension in pregnancy and delivered women at the Teaching Hospital of Brazzaville and identify epidemiological aspects and risk factors. PATIENTS AND METHODS: A prospective and transversal study was realized from november 2004 to january 2005 in the Teaching Hospital of Brazzaville. Forty two patients (8 pregnant women, 34 delivered) with hypertension, have been enregistered among 825 admissions in the departments of gynecology and obstetric. Arterial hypertension was defined by a blood pressure at 140/ 90 mm Hg or above. RESULTS: Arterial hypertension constituted 5.1% of the total admissions. Average of the patients was 27 +/- 8 years (age range: 14 and 40 years). Two patients (4.8%) haven't been sent to school, 29 (69%) had the secondary level, twenty (47.8%) were housewives. Seventeen patients (40.5%) had realized 2 prenatal consultations at the most. Patients were divided in 4 groups: Chronic hypertension (n = 4), pre eclampsia surimposed on chronic hypertension (n = 4), pregnancy hypertension only (n = 15), preeclampsia (n = 19). Prim gravidity (38.1%) and family history of hypertension (40.4%) were the most frequent risk factors. Obesity, gemality, previous pre eclampsia represented respectively 14.3%, 9.5% and 4.8%.

[Teenage pregnancy and delivery: 276 cases observed at the Brazzaville University Hospital, Congo]. / Grossesse et accouchement chez l'adolescente au Congo. A propos de 276 cas au CHU de Brazzaville.

OBJECTIVE: To study sexuality, pregnancy and delivery in female teenagers. MATERIALS AND METHODS: Cross-sectional prospective study from January 1(st), 1997 to May 31(st), 1998 concerning 276 female teenagers. The studied features were compared with a control group of 300 women aged more than 18 years chosen at random. RESULTS: Among 5204 women who delivered during the study period, 5.30% were teenagers. Their mean age was 14 years five months; 84.06% were single; 2.90% were married and 13.04% were concubines. Analysis of social background showed that 41.66% had attended school, 51.10% had dropped out, and 7.24% were illiterate. Mean age at first sexual intercourse was 13 years 9 months. Only 14.13% practised contraception, none used a condom. Mean term of the first prenatal consultation was 26 weeks gestation. Predominant pathological conditions observed during pregnancy were infections, anemia and complications of high blood pressure. Mean term at delivery (generally vaginal) was 38 weeks gestation. The rates of perinatal mortality and referral to the department of neonatology were higher than in the control population. CONCLUSION: Risk remains high for teenage pregnancy. Reduction of complication requires combined medical, psychological and social management.

[Retrospective study of 34 urogenital fistulas of obstetricalal origin]. / Etude rétrospective de 34 fistules uro-génitales d'origine obstétricale.

OBJECTIVES: The aim of the study was to determine the etiologic and epidemiological aspects of the obstetrical uro-genital fistulas in Congo in order to propose a strategy of prevention. PATIENTS AND METHODS: It is a retrospective study concerning 34 files of obstetrical uro-genital fistulas selected within 7 years in the department of Urology of the University Hospital Center of Brazzaville. The etiopathogenic, anatomoclinical and therapeutic aspects have been analysed for each file. RESULTS: The uro-genital fistula represents 23% of the female admissions in urology and 85% of them are related to obstetrical causes. Fifty-five percent of the patients were less than 30 years old, most of them being primiparas. Sixty-one percent of the patients came from rural areas. The prolonged time of the delivering labour and the foetal extraction manoeuvres were the main mechanisms causing the fistulas. With the surgical therapy, 77% of the abnormalities have been treated. CONCLUSION: In spite of progress made in the realm of surgical techniques, the best treatment for uro-genital fistulas remains their prevention as targeted on the education for health and the management of pregnant women. Besides, the development of the infrastructure of health and roads, the training and reeducation of the health personnel contribute to improve this management.

[Maternal mortality in Brazzaville (1993-1994)]. / Mortalité maternelle à Brazzaville (1993-1994).

OBJECTIVE: The purpose of this cross-section study is: to determine the maternal mortality rate in Brazzaville, Congo; to identify the main pathologies and associated risk factors; to suggest appropriate courses of a action in order to reduce the mortality rate. STUDY DESIGN: Records from the Brazzaville Central Hospital, the morgue and the city districts were used to study all the cases of women aged 15 to 44, who died from May 1 1993, to April 30 1994. Cases of maternal mortality were selected. RESULTS: One hundred forty-three cases of maternal death were registered for 35,000 live births, giving a rate of 408 per 100,000 live births. Death in childbirth represents the third mortality factor in mothers-to-be, well behind AIDS and respiratory infections. The main direct factors are: obstetrical hemorrhagies (40.55%), post-abortion infections (18.85%), post-delivery infections (12.69%), eclampsia (11.18%), AIDS (4.19%). AIDS is the main indirect obstetrical and the primary mortality factor in mothers-to-be. CONCLUSION: These findings suggest that the reduction of maternal mortality in Brazzaville has to be correlated with: the need for widespread information about the importance of pre-natal consultations, the need for efficacious action against the spreading of AIDS by common use of condoms, the fight against clandestine abortions, the provision of hospitals with appropriate equipment for the treatment of emergencies.

[Choriocarcinoma after a normal pregnancy. A case report observed in Brazzaville]. / Choriocarcinome après un accouchement normal. A propos d'un cas observé à Brazzaville.

Choriocarcinoma usually occurs following molar pregnancy and is uncommon following normal pregnancy. This report describes a case of choriocarcinoma in a Congolese woman 2 months after normal full-term birth of her first child. Diagnosis was suspected based on ultrasonographic findings and massive elevation of plasma beta HCG and confirmed by histologic study of placental specimens. The disease progressed rapidly despite chemotherapy and death occurred 7 months after confirmed diagnosis with multiple metastases. The incidence of choriocarcinoma after normal pregnancy is estimated to be only 0.18 cases per 1000 pregnancies in Black Africa. This low incidence increases the likelihood of late diagnosis and increases the severity of prognosis. The poor availability of antitumor drugs is a major handicap for management of these patients in developing countries. Under these conditions, the authors recommend immediate hysterectomy if metastasis has not occurred.

[HELLP syndrome. Two cases observed at the University Hospital Center of Brazzaville (Congo)]. / Le HELLP syndrome. A propos de deux cas observés au CHU de Brazzaville (Congo).

The HELLP syndrome is almost always encountered in patients with gravid hypertension. It is defined as the association between intravascular haemolysis, raised liver transaminase levels and thrombopenia. We report 2 cases of HELLP syndrome observed in the Gynecology-Obstetrics B ward in the Brazzaville (Congo) University Hospital in 1992. Frequency in the ward was estimated at 2.9% (2 cases among 67 patients hospitalized for pre-eclampsia). The two cases occurred at 29 weeks gestation in young, black, primipartants in a context of severe pre-eclampsia. The clinical course was rapidly favorable for the mother after delivery. One in utero fetal death occurred. Due to the number of maternal deaths recorded in the literature, we suggest that, in Africa, pregnancies should be interrupted in case of HELLP syndrome whatever the gestational age since proper medical facilities are need to care for these severe cases.

[Prevalence of hepatitis B viral markers in a population of pregnant women in Brazzaville (Congo)]. / Prévalence des marqueurs du virus de l'hépatite B dans une population de femmes enceintes à Brazzaville (Congo).

The risk of perinatal transmission of hepatitis B virus is well-known; but, in Congo, where hepatitis B virus is endemic and the prevalence of hepatocellular carcinoma is high, there is no study on this mode of transmission. For three months, we screened systematically for HBsAg in 292 pregnant women who came as outpatients or to deliver in 3 health centres in Brazzaville. Positive sera for HBsAg were also tested for the other markers of HBV, except for specific DNA. The seroprevalence of HBV among these women was 6.5%. It was significantly higher among inpatients than among outpatients. The overall prevalence of HBs was 57.8%; the prevalence of the profile HBsAg + HBeAg was 2.05%. The risk of maternofoetal transmission of HBV was 2.7%. This study shows that the antenatal screening for HBV and the integration of the immunization against HBV in the expanded programme of immunization against HBV are good means to prevent the infection.

[Uterine rupture in an African environment. 59 cases at the University Hospital Center in Brazzaville]. / Les ruptures utérines en milieu africain. 59 cas colligés au CHU de Brazzaville.

A retrospective study of 59 uterine ruptures was conducted at the University Hospital in Brazzaville. The frequency fo uterine ruptures in this institution was found to by 0.7% among the 8,138 women who delivered between 28 ans 42 weeks amenorrhoea. The duration of this study was 26 months from 1 September 1989 to 31 October 1991. The mean age of the women was 26.5 years. Most had been transferred from peripheral centres (84.7%). The predominant aetiological circumstances were: multiparity (94.9%), cicatricial uterus (35.6%), poorly controlled use of ocytocic agents (32.2%) and mechanical dystocia (30.5%). The uterine ruptures were often complete (64.4%) and diagnosed in the perpartum period (54.2%). Maternal and foetal outcome was often fatal with 4 maternal deaths (6.7%) and 40 foetal deaths (67.8%). The main effort for prevention and reduction of this dramatic situation in Africa requires personnel training, equipping peripheral centres and improved highway system in order to allow rapid access to well equipped hospitals.

[Hydatid cyst of the breast. Case report]. / Kyste hydatique du sein. A propos d'un cas.

The rarity of mammary echinococcosis leads the authors to report the demonstrative case of a 45-year-old woman, para 9, gravida 9, who had always breast fed, undergoing surgery for a cyst of the right breast and which was found histologically to be a hydatid cyst. Progression of the tumour was particularly slow (approximately 10 years). Mammography forms an essential part of pre-treatment evaluation since it enables circumscription of the lesions and study of regional lymph nodes which are normal in all cases. At any event, cystectomy is the only effective method of treatment, recognised by all authors. Clinical and mammographic evaluation after 2 years of our patient was normal.

[Prenatal diagnosis of cystic hygroma of the neck by echography. Case report. Review of the literature]. / Diagnostic anténatal de l'hygroma kystique du cou par l'échographie. A propos d'un cas. Revue de la littérature.

The authors report a case of hygroma colli, diagnosed in utero by ultrasonography, in Africa, at the Brazzaville (Congo) Teaching Hospital. The ultrasonographic appearances as well as the differential diagnostic aspects of hygroma colli are defined. Because of the frequent association with chromosomal aberrations, the authors suggest the termination of pregnancy in an African context, since karyotyping is not possible in that part of the world.

[A case of neurofibroma of the vagina. Review of the literature]. / Un cas de neurofibrome du vagin. Revue de la littérature.

Large tumours of the vagina are rare. If a vaginal neurofibroma is found a search should be made for other sites of Recklinghausen's disease. The tumour should be removed surgically to avoid risk of degeneration.

[Endometrial ossification. Apropos of 5 recent cases]. / Ossification endométriale. A propos de 5 observations récentes.

Five cases of ossification of the endometrium that have been seen in the course of five years are reported. Special attention is paid to a case that occurred in the post-partum period. Several different hypotheses as to the aetiology of the pathology of this condition are discussed yet again; the only one that seems likely to be possible is that these ossifications start as metaplasias. The clinical, paraclinical and therapeutic angles are also dealt with.