[Post-partum sexuality. Living in black African couple analysis]. / La sexualité du post-partum. Analyse du vécu dans le couple noir africain.

INTRODUCTION: The period of the post-partum arouses a lot of questioning in the couple in particular regarding sexuality. OBJECTIVE: Analyze the real-life experience of the sexuality of the African black couples in the post-partum. PATIENTS AND METHOD: It was about study type attitudes and practical knowledge which took place in the department of gynecology-obstetrics and andrology of the teaching hospital of Bouaké over the period going in September 30th, 2012 on April 30th, 2013. The study took place in two stages. The first stage had consisted in a pre-test which allowed validate the questionnaire which contained 16 items. The second stage consisted submitting it directly to the patients, in postnatal consultation, who had agreed to participate in the study after an informed consent. The data were analyzed with epi-info, 2002 version. RESULTS: On 395 patients investigated, we noted the resumption of the sexual intercourse for 140 patients (34,2 %). The resumption was made on the initiative of the partner in 67,9 % of the cases, in particular after the return of menstruation (53,8 %). The reason to accept sexual intercourse was to satisfy the partner (60,7 %) and to maintain the harmony of the couple (57,1 %). However, the weekly frequency of the sexual intercourse had decreased in 75 % of the couples. This decrease was caused by the time dedicated to the child (66,7 %) and by the dyspareunia (57,1 %). We also observed a more important frequency of the anal sexual intercourse in the post-partum compared with the period before the childbirth (17,8 % vs. 3,57 %). Also, the use of subtleties, such as lubricants was observed more frequently in the post-partum (39,3 % vs. 3,6 %). Sixty-four comma three percent of the patients had found less satisfaction sexual intercourse. Dyspareunia was more frequent in case of episiotomy, perineal tear during the delivery and delivery assisted (vacuum). The patients, in 51 % of the cases, were themselves responsible for the refusal of the resumption of the sexual activity. The reasons of the refusal were of cultural and religious order and in touch with the absence of the return of menstruation in respectively 64,7 % and 54,9 % of the cases. CONCLUSION: The delivery had a negative impact on the resumption of couple sexual activity. Also, we noted a strong influence of the cultural and religious faiths on the sexual practice of the post-partum in the absence of reliable information. A particular attention should be concerned by the medical profession on the question of sexuality in the post-partum.

Bilan d'activite coelioscopique dans un hopital secondaire. cas de l'hopital general d'Ayame (Cote d'Ivoire)

Objectif. Etablir le bilan de l'activite colioscopique a l'Hopital General d'Ayame Methode. Il s'agissait d'une etude retrospective et descriptive qui s'etait realisee a l'hopital general d'Ayame et qui concernait tous les actes coelioscopiques effectues dans le service de gynecologie et d'obstetrique du 02 janvier 2013 au 30 juin 2014. Nous avions etudie les caracteristiques socio-demographiques des patientes; les indications; les actes operatoires (diagnostiques et therapeutiques) et la morbidite postoperatoire. Resultats. Il a ete realise 45 interventions percoelioscopiques; soit 21% de l'activite chirurgicale gynecologique de l'hopital. Les patientes avaient un age moyen de 33;1 ans avec des extremes de 24 et 44 ans. Il s'agissait en majorite de nulligestes et primigestes (66%); de nullipares (71%); de cadres et de niveau scolaire superieur (48;8%); residant a Abidjan (66;6%) et vivant maritalement (75%). L'infertilite et la seconde consultation post-myomectomie etaient les indications avec respectivement 67% (30 cas) et 33% (15 cas). Les constatations per operatoires pour infertilite etaient dominees par les adherences periannexielles; les kystes ovariens et les obstructions tubaires avec des frequences respectives de 33%; 27% et 23%. L'adhesiolyse et la kystectomie representaient les actes chirurgicaux les plus realises dans des proportions respectives de 53;3% (24 cas) et 13;3% (6 cas). Dans tous les cas de seconde consultation postmyomectomie; nous avions note des adherences parmi lesquelles predominaient les type II (60%). Aucune complication operatoire n'avait ete observee. Conclusion : la colioscopie est realisable en dehors des structures sanitaires de niveau tertiaire. Une mise a niveau du personnel pourrait ameliorer sa pratique

Analyse situationnelle de la mortalite perinatale au CHU de Bouake: resultats d'une etude portant sur le 1er semestre 2011

Contexte la mortalite perinatale represente une situation frequente malheureusement peu analysee; alors qu'elle constitue un parametre important dans l'evaluation de la qualite des soins. Objectif : Analyser la situation de la mortalite perinatale afin d'en preciser les facteurs favorisants. Patientes et methode : il s'agissait d'une etude retrospective descriptive exhaustive qui s'est deroulee a la maternite du CHU de Bouake; couvrant le 1er semestre de l'annee 2011. Elle a concerne tous les cas de deces feotaux enregistres directement dans le service apres accouchement et les enfants evacues en pediatrie qui y sont decedes. Nous avons analyse les caracteristiques epidemiologiques des meres; les circonstances de l'accouchement et les facteurs pouvant expliquer les deces fotaux Resultats : la mortalite perinatale representait 122 des accouchements de la periode d'etude. Cent vingt six enfants; soit 68;9; etaient morts pendant le travail. En pediatrie; vingt cinq nouveau-nes (13;70) y etaient morts. L'age moyen des patientes etait de 30 ans et la tranche d'age la plus representee etait celle des adolescentes avec un taux de 29;5. Il s'agissait aussi en majorite des femmes au foyer (86;3); primipares (26;8); avec antecedents de deces neonataux (38;8); un age variant de 25-34 ans (44;8); et provenant de la ville de Bouake (61;2). Les patientes etaient a 84;7 admises apres une evacuation dont les principaux motifs etaient la dystocie mecanique (24;6) et les metrorragies (13;66). L'accouchement des fotus morts s'etait realise par la cesarienne et par la laparotomie dans respectivement 39;3 et 14;8 des cas. Les indications de cesarienne etaient essentiellement l'epaule negligee et le syndrome de pre-rupture uterine a un taux identique de 20;83; et l'hematome retro-placentaire dans 19;4 des cas. En l'absence d'autopsie; les causes les plus probables des deces etaient le travail prolonge (38;89); l'hypertension arterielle (10;92).Conclusion : la mortalite perinatale est elevee au CHU de Bouake. Les causes sont essentiellement les dystocies mecaniques; dont la prise en charge adequate devrait permettre de reduire sa prevalence

[Reality of the impact of pregnancy on sexuality. Results about review of 200 Ivoirians pregnant women]. / Réalité de l'impact de la grossesse sur la sexualité. Résultats d'une enquête auprès de 200 gestantes ivoiriennes.

BACKGROUND: Sexuality during pregnancy is a subject little approached during the antenatal follow-up while it sometimes constitutes a source of preoccupation for pregnant women for the preservation of the harmony of the couple. OBJECTIVE: Determine the opinions and the practices of women in sexuality during pregnancy. PATIENTS AND METHOD: Prospective transverse study of type knowledge practical attitude which took place from September 1st, 2008 to February 28th, 2009 at the General Hospital of South Abobo. It concerned 200 pregnant women who agreed to answer a pre-tested questionnaire, with their confirmed pregnancy. RESULTS: It is noted that 95,5% of pregnant women consider that it is possible to have sexual relations during the pregnancy. So 89% of them continue to have sexual relations during their pregnancy. The continuation of the sexual activity aims mostly at satisfying the pleasure of the woman and her partner (34,4%). Twenty-six percent of the questioned women consider that the sexual relations can have consequences on the pregnancy and that they would be responsible, for 60,9% of them, for miscarriages. Nine of 22 patients who observe a sexual abstinence during their pregnancy are afraid of hurting their fetus. Only 21,1% of pregnant women have appealed to the medical and paramedical staff to inquire on sexuality during pregnancy. They assert in 81,6% to have a decline of the libido and 54,7% find the sexual relations less satisfactory than before the pregnancy. CONCLUSION: The pregnancy influences negatively the sexual practices during the pregnancy. Pregnant women are badly informed and convey prejudices. The medical staff should offset for this deficit of information by daring to speak about it during the antenatal visits.

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.