ABSTRACT
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.
Subject(s)
Pregnancy Complications/mortality , Urban Health , Adolescent , Adult , Cause of Death , Congo/epidemiology , Cross-Sectional Studies , Female , Health Services Needs and Demand , Humans , Maternal Mortality , Population Surveillance , Pregnancy , Pregnancy Complications/etiology , Pregnancy Complications/prevention & control , Retrospective Studies , Risk FactorsABSTRACT
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.
Subject(s)
Choriocarcinoma/diagnosis , Puerperal Disorders/diagnosis , Uterine Neoplasms/diagnosis , Adult , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Choriocarcinoma/drug therapy , Congo , Fatal Outcome , Female , Humans , Incidence , Pregnancy , Prognosis , Puerperal Disorders/drug therapy , Uterine Neoplasms/drug therapyABSTRACT
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.
Subject(s)
HELLP Syndrome , Abortion, Therapeutic , Adult , Congo , Female , HELLP Syndrome/diagnosis , HELLP Syndrome/etiology , HELLP Syndrome/therapy , Humans , Pregnancy , Pregnancy Outcome , Prognosis , Risk FactorsABSTRACT
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.
