[Transfer of obstetric patients in a pregnant and postpartum condition to an intensive care unit: eighty-two cases in Burkina Faso]. / Transfert de patientes en état gravido-puerpéral en réanimation: à propos de 82 cas au Burkina Faso.

OBJECTIVE: To review all obstetric admissions to an intensive care unit (ICU) of an African hospital. PATIENTS AND METHODS: Retrospective analysis of the records of all obstetric patients admitted to the ICU of Souro Sanou Hospital in Burkina Faso, from January 1st, 1996, to June 30, 1998. RESULTS: Eighty-two patients out of 6119 deliveries were transferred to the ICU, which meant a 1.34% transfer rate. These transfers concerned young patients (mean age of 24 years), coming originally from outlying maternities in 52.4% and having already given birth in 64.63% of the cases. The two main diagnoses at the ICU were: eclampsia and septic shock. The large majority of the patients (73 out of 82) had at least one bad prognosis factor at admission at the ICU. A maternal mortality rate of 60% was noted, the main risk factors for mortality being acute respiratory condition and severe anemia. CONCLUSION: Mortality of obstetric patients admitted to ICUs is very high in our setting. Establishing an ICU within the obstetric unit or early detection of cases to be transferred (scoring system?) should improve the prognosis.

[Hysterectomies in tropical zones: experience of one African maternal health service. 141 cases in Burkina Faso]. / Les hystérectomies en zone tropicale: expérience d'une maternité africaine. A propos de 141 cas au Burkina Faso.

We conducted a retrospective study of all hysterectomies performed in our setting over a two year period (1995-1996). The objective was double: define the indications and precise the outcome. A total of 141 cases were recorded. The main characteristics of the patients were the following: a mean age of 38 years, mean gravidity and parity of 5 and an average number of living children of 3. Hysterectomy was performed by the abdominal route in 86.52% of the cases. The main indications were: uterine rupture (39.71%), uterine myoma (25.53%), genital prolapse (19.89%) and cervix cancer (7.09%). Adnexectomy was associated in 51 cases and it was bilateral in 22 cases. The following complications occurred: 5 deaths, 8 wound abcess, 2 bladder injury, 1 ureter injury and 1 case of post-operative hemorragea.

[Abdominal pregnancy and tubal pregnancy. Apropos of 1 case. An exceptional clinical event]. / Grossesse abdominale et grossesse tubaire. A propos d'un cas. Un fait clinique exceptionnel.

A case of non-progressive and earlier abdominal pregnancy, associated with an evolutionary tubal pregnancy is reported by the authors. This clinical situation is very rare, indeed, exceptional, because it concerns two successive and ectopic pregnancies. The poor obstetrical cover and the ineffectual supervision of the pregnancy explain in part these situations in our countries.

[Female sterilization in Burkina Faso. Report of 142 cases]. / La stérilisation féminine au Burkina Faso. A propos de 142 cas.

Through a transversal study over a twelve month period, the authors report 142 cases of female sterilization (FS) in Burkina Faso. The aims of this study were to determine the profile of women undergoing FS and to precise the indications and the immediate outcome. The study took place in the two main gynecologic and obstetric units of the country. Various data about the socio-demographic characteristics of the women, their reproductive history, the indications for the FS and the short term follow up were recorded. The woman undergoing tubal ligation (TL) is 36 years old, gravida 7 para 7 with 5 children (3 boys for 2 girls). Her occupation is housewifery, she is married and is illiterate in 84.4% of the cases. This woman has no prior history of contraceptive use in 71% of the cases. FS was performed for medical reasons in 50% of the cases whereas economic reason was invoked by only 5% of the couples. Prior to the TL oral informed consent was obtained from both the woman and her husband. The TL was performed during caesarean section in 55.6%, in the postpartum period in 34.5% of the cases. Two wound abscesses occurred. With a follow up ranging from 2 to 14 months, no pregnancy has been reported. To give a chance to FS to be popular in Burkina Faso, the authors made some suggestions.

Voluntary female sterilisation via minilaparotomy: report from Burkina Faso.

We present the first study of voluntary female sterilisation in Burkina Faso. The average woman undergoing tubal ligation was a 37 year old, married, house wife para 8 with five living children. The main reasons for TL were: achieved desired family size (45.9%) and medical reason (29.5%). The TL was usually performed (77.8%) in the postpartum, using the Pomeroy technique. With a follow up of three to fifteen months, no pregnancy has been reported and no request for reversal expressed. The authors make some suggestions to increase the prevalence of TL in Burkina Faso.

PIP: In the first study of female sterilization in Burkina Faso, case records of the 63 women undergoing minilaparotomy in the 12-month period between June 1, 1995, and May 31, 1996, at the country's second largest obstetric and gynecologic unit (Centre Hospitalier National Sanou, Bobo Dioulasso) were reviewed. Acceptors ranged in age from 27 to 45 years (mean, 37.36 years) and had an average of 5 living children; 55.6% were in polygamous marriages and 65.1% were Muslim. 32.3% reported prior use of a modern contraceptive method, primarily the pill. The decision to undergo sterilization was made by both partners in 50.8% of cases and by the husband alone in 23%. Achievement of desired family size was the primary reason (45.9%) for sterilization; another 29.5% were motivated by medical reasons. 77.8% of procedures were performed in the postpartum period. The Pomeroy method was used in all cases. Women were discharged from the hospital on the same day as the procedure. There were no sterilization-related complications in this series, and no pregnancies or requests for reversal have occurred in 3-15 months of follow up. It is recommended that Burkina Faso establish a national voluntary female sterilization program, equip peripheral health centers with minilaparotomy kits, and train physicians and medical students to perform the procedure.

[Measles and pregnancy. Apropos of 16 cases in Burkina Faso]. / Rougeole et grossesse. A propos de 16 cas, au Burkina Faso.

We report an epidemic of 16 cases of measles during pregnancy. The risk factors for such an association and the materno-fetal outcomes are presented. The mean age of the patients was 20.6 years, with a mean gravidity and parity of 2.1 and 1.1 respectively. The mean clinical features were: conjunctivitis, hyperthermia and cutaneous rash. Nine maternal complications occurred: 6 laryngitis and 3 pneumopathies. All patients were HIV negative. The outcomes of the pregnancy were the following: 2 abortions, 3 stillbirths, 1 preterm delivery and 2 full term births. Eight patients with ongoing pregnancies were lost to follow-up after their discharge from the hospital. We conclude on the need for a systematic prevention in exposed pregnant women by immunotherapy and in children by immunization.

Place de l'echographie dans le diagnostic des grossesses extra-uterines (GEU) au C.H.N. SS. de Bobo-Dioulasso (Burkina-Faso) de 1993 a 1995

Une etude retrospective sur dossier a ete menee; du 1/1/93 au 1/5/95 au Centre Hospitalier National Sanou Sourou de Bobo-Dioulasso afin de determiner la place de l'echographie dans le diagnostic des grossesses extra-uterines dans cette formation sanitaire; d'en apprecier les formes cliniques; les aspects echo-anatomiques et d'en analyser la semiologie. 96 GEU ont été opérées sur cette période. La fréquencedes GEU est de 1 pour 62 accouchements. L' é c h o g r a -phie est peu utilisée au C.H.N. SS. comme moyen de dia-gnostic (24% des GEU), après la ponction péritonéale (72,8%). Le tableau échographique est dominé par lessignes indirects de GEU. L'aspect écho-clinique et ana-tomique prédominant est le tableau d'inondation périto-néale par rupture de la grossesse (91%). La localisation anatomique préférentielle est tubaire (85,4%) puisabdominale (9,8%). Une action de formation doit être menée au niveau péri-phérique, intermédiaire et central de notre système desanté pour une meilleure gestion des grossesses à risque

Etiologic study of genitourinary infections in women of childbearing age in Bobo-Dioulasso, Burkina Faso, 1992.

BACKGROUND AND OBJECTIVES: Genitourinary infections have a major impact on public health, especially in Africa. Relative distribution of the different pathogens is unknown in Bobo-Dioulasso. GOAL: To describe the etiology of genitourinary infections, to establish the sensitivity of Neisseria gonorrhoeae to antibiotics, and to provide epidemiologic and biologic evidence to optimize the treatment of genitourinary infections. STUDY DESIGN: Clinical and biologic diagnoses were performed on 223 women with genitourinary infections. RESULTS: Etiologies found were trichomoniasis (27.8%), chlamydia (26.9%), bacterial vaginosis (19.7%), candidiasis (16.6), and N. gonorrhoeae infection (10.9%). Human immune deficiency virus antibodies were present in 42% of the patients. Spectinomycin or ceftriaxone should be recommended for the treatment of gonorrhoeae in Bobo-Dioulasso. CONCLUSIONS: The prevalence of Chlamydia trachomatis is higher than that of N. gonorrhoeae in Bobo-Dioulasso. This should be taken into account in clinical management of sexually transmitted diseases in this setting.

PIP: Genitourinary infections have a major impact upon public health, especially in Africa. This paper describes findings from a study conducted to describe the etiology of such infections in Bobo-Dioulasso, to establish the sensitivity of Neisseria gonorrhoeae to antibiotics, and to provide epidemiologic and biologic evidence to optimize the treatment of genitourinary infections. The findings are based upon clinical and biologic diagnoses among 223 women with genitourinary infections. Study found the following etiologies: trichomoniasis in 27.8%, chlamydia in 26.9%, bacterial vaginosis in 19.7%, candidiasis in 16.6%, and Neisseria gonorrhoeae infection in 10.9%. HIV antibodies were present in 42% of patients. The authors recommend spectinomycin or ceftriaxone for the treatment of gonorrhea in Bobo-Dioulasso. Moreover, that the prevalence of Chlamydia trachomatis is higher than that of Neisseria gonorrhoeae should be taken into account when managing STDs in this setting.

Sexually transmitted diseases and human immunodeficiency virus infection among women with genital infections in Burkina Faso.

This study reports the prevalence of sexually transmitted diseases (STDs) among gynaecological outpatients presenting at the Bobo-Dioulasso Hospital (Burkina Faso) with genital infections and examines the factors associated with HIV infection in this population. Of 245 eligible non-pregnant women, 220 consented to participate in the study. Seventy-seven per cent had sexually transmitted infections. The most common were: Trichomonas vaginalis (28%), Chlamydia trachomatis (27%), bacterial vaginosis (20%), Candida albicans (17%), Neisseria gonorrhoeae (11%). The prevalence of HIV infection was 42% (95% c.i. 35.3, 48.3). Logistic regression analyses revealed Neisseria gonorrhoeae to be the only STD significantly associated with infection with HIV (P = 0.04). A sedimentation rate greater than or equal to 100 mm in the first hour was also associated with HIV infection (P < 0.001). Women consulting for genital infections constitute a high risk group for HIV infection and other STDs. Management of these women should focus on the early diagnosis and treatment of STDs.

PIP: During May-October 1992 in the gynecology and obstetrics department at the National Central Hospital Souro Sanou in Bobo-Dioulasso, Burkina Faso, physicians conducted a physical examination of and took vaginal smears from 220 nonpregnant women of reproductive age who consented to take part in this study and who had clinical signs of a genital infection. The researchers wanted to determine the prevalence of sexually transmitted diseases (STDs) and the factors associated with HIV infection. 77% had an STD. The most common STDs were Trichomonas vaginalis (28%) and Chlamydia trachomatis (27%). 42% were HIV positive. HIV-positive women were significantly more likely than HIV-negative women to be infected with Neisseria gonorrhoeae (30.4% vs. 24.2%; p = 0.03). Risk factors associated with HIV infection among women presenting with genital infections included young age (25.5 vs. 27.5 years; p = 0.03), low gravidity (2 vs. 2.7; p = 0.04), a higher sedimentation rate in the first hour (75.3 vs. 54; p 0.001), and a low hemoglobin level (11.7 vs. 12.2 g/dl; p = 0.01). These findings indicate that women with genital infections are a group at high risk of HIV and other STDs and a target population for preventive interventions. Physicians should focus on detection and treatment of STDs when they manage cases with genital infections, and they should give appropriate advice on the prevention of HIV to all women presenting with genital infections.