Aspects epidemiologiques et etiologiques des couples infertiles a Abidjan

Objectif : Ce travail avait pour objectifs d'identifier les caracteristiques sociodemographiques des couples infertiles et de preciser les principales etiologies. Methode : Nous avons mene une etude retrospective descriptive portant sur 210 couples consultant pour infertilite dans les services de gynecologie du CHU de Treichville et d'une clinique privee de la place durant la periode 1er fevrier 2013 au 30 septembre 2014 (20 mois). Resultats. La prevalence de l'infertilite etait de 14;03%. L'age moyen etait de 34;31 ans chez les femmes et de 43;2 ans chez les hommes. La majorite des patientes avait atteint au moins le niveau d'etude secondaire (77;1%). Les couples residant hors d'Abidjan etaient de 15%; et les differentes couches socio-economiques etaient touchees par l'infertilite. La duree moyenne de vie commune des couples etait de 6;9 ans avec une duree moyenne d'infertilite de 6;3 ans. L'infertilite etait en general de type secondaire; touchant aussi bien les femmes (41%) que les hommes (30%). Les etiologies chez les femmes etaient d'origine uterine (47;06%); hormonale (22;79%) et tubo peritoneale (17;65%). Chez l'homme les troubles du sperme etaient domines par l'oligoasthenospermie (69;91%) d'etiologie generalement infectieuse. Conclusion. l'infertilite etait frequente dans nos services; touchant aussi bien les femmes que les hommes

[An uncommon complication of unsafe induced abortion: bowel prolapse through uterine perforation]. / Une complication rare mais grave des avortements provoqués clandestins : l'évisceration iléale per vaginum.

The authors report one case of bowel prolapse through uterus following induced abortion. The eviscerated bowel was completely gangrenous, devoided from its mesentery and entrapped in the uterus wall. The treatment was a bowel resection and ileo-ileum anastomosis; the uterus was evacuated of retained products of conception and then sutured. The patient recovered uneventfully; fertility prognosis is expected to be poor because of abortion sequelae. If the abortion law still remains in Ivory Coast, more effort should be directed at reducing the incidence of unwanted pregnancy. This could be best archived by a better information on contraception and better health education programs.

Les hemorragies de la delivrance : a propos de 134 cas referees a la maternite du CHU de Treichville

Objectifs : Determiner la frequence des patientes referees pour hemorragie du post partum immediat (HPPI); decrire les caracteristiques socio-demographiques des patientes et identifier les dysfonctionnements pouvant aggraver le pronostic maternel. Population et methode : Etude descriptive et retrospective menee de janvier 2005 a juin 200 incluant toutes les patientes referees a la maternite du CHU de Treichville pour HPPI. Resultats : 134 patientes ont ete referees pour HPPI soit une incidence de 1;27. L'age moyen des patientes etait de 28;5 ans. La parite moyenne etait de 3;5. La majorite des patientes etaient sans activite remuneratrices et sans niveau d'instruction. La decision de transfert etait decidee dans 85;82 des cas par la sage femme. Le transfert avait ete assure par de vehicules non medicalises (86;58). La duree moyenne d'evacuation etait de 62;7min. A l'admission; 47;76 etaient en etat de choc hypovolemique avec dans 16;42 une coagulation intravasculaire disseminee. Trente et six patientes sont decedees soit un taux de letalite de 26;90. Les principales causes de deces etaient la coagulopathie (55;6) et le choc hypovolemique (36;1). Conclusion : Le taux de letalite par hemorragie de la delivrance chez les patientes referees est eleve. Sa reduction passe par l'amelioration des dysfonctionnements identifies dans l'itineraire therapeutique des patientes

Tuberculosis of the cervix and infertility: report of a rare case.

Tubercolosis is a frequent bacterial infection in less developed countries. Lung and lymph node localisations are common, while the genital apparatus is less involved. In this work a rare case of cervical tuberculosis followed by some lesions causing infertility in a 20-year-old woman is reported. The diagnosis was confirmed by a histological examination from a biopsy of the cervix. The patient was offered six-month antituberculosis therapy which eliminated the cervical lesions. A few years later she came under our care for infertility due to uterine adhesions diagnosed by hysterosalpingography. Now the patient is being treated for infertility complicated by amenorrhoea.

[Frequency of cord prolapse: etiological factors and fetal prognosis in 47 cases in a health center]. / La procidence du cordon: facteurs etiologiques et pronostic foetal a propos de 47 cas colliges dans un centre de sante de reference.

UNLABELLED: Cord prolapse constitute an imprevisible accident of the period of labor and an important cause of perinatal mortality. The aim of our study was to determine the frequency of cord prolapse, its etiological factors and to evaluate fetal prognosis. MATERIAL AND METHODS: Our study was done in the department of obstetric and gynecology of the Treichville university teaching hospital. It is a descriptive prospective study that covers 4 years period, from January 1st 1997 to December 31st 2000. RESULTS: We did record 16.924 deliveries with 47 cases of cord prolapse representing a frequency of 0.28% The influencial factors for occurrence of cord prolapse were: prematurity, multiple pregnancy, dystocic presentations and spontaneous rupture of membranes. 28% of our patients had pregnancy not at term. Twin pregnancies represented 23.4% and in 91% of the cases, prolapsed concerned the second twin. Our rate of cord prolapse associated with vertex presentation was 23.4%; 42.5% in breech and 12.8% in the case of shoulder presentation. Spontaneous rupture of membranes was the most frequent type. In 61.7% of the cases, the delivery was done by caesarian section. Cord prolapse was greatly lethal for the fetus with 36.2% of death occurring before the 5th minute of life. CONCLUSION: Umbilical cord prolapse is a grave obstetrical complication that compromises fetal prognosis.

Uterine torsion with maternal death: our experience and literature review.

Torsion of the gravid uterus around its cervical junction is a rare event especially in humans. In 1992, a literature review by Jensen, mentioned by Carbonne, showed 212 cases with different etiologies. Uterine torsion is more frequently dextrorotatory (2/3 of cases). The diagnosis is difficult and generally done during cesarean section because it is frequently not symptomatic. Uterine torsion signs, when present, are not specifics. Pain, nausea and vomiting may present without any sign of shock, as in our patient. Sometimes ultrasonography can lead to a correct diagnosis, showing a modification of the placenta site during pregnancy, or an abnormal positioning of the ovarian vessels which pass in front of the lower uterine segment. Some authors report cardiotocographic abnormalities probably due to the reduction of blood flow caused by the torsion. Quickness of surgical treatment is fundamental for the reduction of fetal mortality which is very frequent in a large number of cases, while maternal mortality is not so frequent but possible. A diligent anamnesis and ultrasonographic examination are surely useful to single out the rare cases of uterine torsion in pregnancy.

[ Hypoxia of the fetus and neonate of a diabetic mother. Importance of hemorheologic anomalies]. / Hypoxie du foetus et du nouveau-né de mère diabétique. Importance des anomalies hémorhéologiques.

Death in utero (or immediately following birth) of children of diabetic mothers remains rather mysterious. Next to abnormalities of carbohydrates metabolism, hypoxia appears to be a determining factor of the frailty of children of diabetic mothers. Now, the so called "hemorheologic" alterations, which means the difficulties derived from the blood discharge by increased viscosity, represent a cause of hypoxia as well as an aggravating factor of hypoxia. This study demonstrates the abnormalities of blood viscosity in diabetic patients, which, in association with hypercoagulability, aggravate fetal anoxia.