[Breech presentation: mode of delivery and maternal and fetal outcomes at the Ignace Deen Clinic of Gynecology and Obstetrics, Conakry University Hospital]. / Presentation de siege: mode d'accouchement et pronostic maternal-foetal a la Clinique de Gynecologie Obstetrique Ignace Deen du CHU de Conakry.

The authors in a prospective, analytical study of 8 months from January 1st to August 31st performed at the Ignace Deen Clinic of Gynecology and Obstetrics, Conakry University Hospital; assessed the impact of the mode of delivery in breech presentation on maternal and fetal outcome in the African context of Guinea. Breech presentation in mono fetal pregnancy of at least 28 weeks of amenorrhea was the inclusion criterion in this study. Among 1490 deliveries, 144 breech presentations were reviewed, representing a frequency of 9.66%. Half of breech deliveries (49.99%) were premature against only 11.85% in cephalic presentations. The breech was incomplete in 57.64% cases and complete in 42.35%. Caesarean section was performed in 40.97% of cases against 39.54% in cephalic presentation. The indications were often primiparity (30.50%), acute fetal distress (28.81%) and macrosomia (23.72%). Deliveries through the lower route frequently used the maneuver of Bracht (52.50%). 54.16% of the new-born babies had a fetal weight lower than 2500 g at born. Morbid Apgar score at the 1st minute after delivery through the lower route was found in 69.40% of the breech presentation born babies; however, this rate was 32.70% in cephalic presentation (p=0.000). The maternal morbidity concerned essentially perineal lesions (26.53%). The outcome is largely better in case of delivery through the upper route. The caesarean section is an alternative for the improvement of fetal outcome in countries with low resources.

Presentation de siege : mode d'accouchement et pronostic materno-feotal a la clinique de gynecologie obstetrique Ignace Deen du CHU de Conakry

Les auteurs dans une etude prospective de type analytique de 8 mois; allant du 1er janvier au 31 aout 2006; realisee a la clinique de gynecologie obstetrique de l'hopital Ignace Deen du CHU de Conakry; ont evalue l'impact du mode d'accouchement dans la presentation du siege sur le pronostic materno-foetal dans le contexte africain guineen. La grossesse mono foetale en siege d'au moins 28 semaines d'amenorrhee a ete le critere d'inclusion.Sur 1490 accouchements; 144 presentations de siege ont ete colliges; soit une frequence de 9;66. La moitie des accouchements en siege (49;99) etait prematuree contre seulement 11;85en sommet. Le siege etait decomplete dans 57;64des cas et complet dans 42;35. La cesarienne a ete realisee dans 40;97des cas; contre 39;54dans la presentation du sommet. Les indications etaient le plus souvent la primiparite (30;50); la souffrance foetale aigue (28;81) et la macrosomie (23;72).Les accouchements par voie basse avaient recours plus frequemment a la manoeuvre de Bracht (52;50). 54;16des nouveaux nes avaient un poids foetal inferieur a 2500 g a la naissance. L'Apgar morbide a la 1ere minute; apres accouchement par voie basse; a ete retrouve chez 69;40des nouveaux nes en siege ; alors que ce taux en sommet etait de 32;70(p=0;000). La morbidite maternelle concernait essentiellement les lesions perineales (26;53).Le pronostic est largement meilleur lors de l'accouchement par voie haute. La cesarienne est une alternative pour l'amelioration du pronostic foetal dans les pays a ressources limitees

[Management of ectopic pregnancy in Conakry, Guinea]. / Prise en charge de la grossesse extra utérine à Conakry (Guinée).

Ectopic pregnancy is one of the most frequent hemorrhagic emergencies encountered in gynecology and obstetrics. The purpose of this 16-month descriptive prospective study at the Ignace Deen Gynecology-Obstetric clinic at Conakry University Hospital in Guinea was to assess diagnostic techniques and therapeutic attitudes regarding ectopic pregnancy in a low-resource setting. The frequency of ectopic pregnancy was 1.4%. Mean patient age was 28.9 years. Ectopic pregnancy was often observed at the second or third pregnancy (47.1%) in women who were giving birth for the second or third time (36.0%) and had a history of sexually transmitted infections (88.2%) or abortions (43.1%). Most women had no schooling (60.8 %), were poor and lived in a marital home (86.3%). Presenting symptoms included the classic triad of amenorrhea (98.0%), abdominopelvic pain (92.2%), and vaginal bleeding (62.7%). Definitive diagnosis was achieved by ultrasound examination in 76.6% of cases and by puncture of the Douglas pouch in 84%. The most frequent site of ectopic pregnancy was the ampulla of the uterine tube (66.9%). Abdominal and ovarian pregnancy was observed in 3 and 4 of the 51 cases respectively. Surgical management was performed in all cases. The most frequent procedure was salpingectomy (80.3%). Proper treatment of sexually transmitted infections (STI), start-up of post-abortion care facilities, and provision of information during early consultation at the first signs of pregnancy would help reduce the frequency and improve the prognosis of ectopic pregnancy.

Prise en charge de la grossesse extra uterine a Conakry (Guinee)

La grossesse extra uterine (GEU) est l'une des principales urgences hemorragiques rencontrees en milieu gyneco-obstetrical. Les auteurs; dans une etude prospective; descriptive; d'une duree de 16 mois a la clinique de gynecologie obstetrique de l'Hopital Ignace Deen du CHU de Conakry; ont ressorti la place des moyens diagnostiques et degage les attitudes therapeutiques dans un contexte de travail ou les ressources sont limitees. La frequence de la GEU etait de 1;4; la moyenne d'age des patientes etait de 28;9 ans. Dans 47;1des cas; la GEU survenait a la deuxieme ou a la troisieme grossesse; chez les femmes qui accouchaient pour la deuxieme ou la troisieme fois (36;0) avec des antecedents d'infections sexuellement transmissibles (88;2) ou d'avortements provoques (43;1). Ces femmes etaient non scolarisees (60;8); issues de milieux defavorises et vivaient dans un foyer conjugal (86;3). La triade amenorrhee (98;0); douleurs abdomino-pelviennes (92;2); metrorragie (62;7) a ete la principale revelatrice de la GEU. L'echographie a ete concluante dans 76;6des cas et la culdocentese dans 84. Le siege de la GEU a ete le plus souvent ampullaire (66;7). Nous avons note 3 cas de grossesse abdominale et 4 cas de grossesse ovarienne sur 51 cas de GEU. Dans tous les cas la prise en charge a ete chirurgicale et le geste le plus frequent etait la salpingectomie (80;3). La prise en charge des IST; l'instauration d'unites de soins apres avortement et la sensibilisation a la consultation precoce devant les signes de grossesse contribueraient a la reduction de la frequence de la GEU et a l'amelioration de son pronostic

Illegal or unsafe abortion in Guinea.

PIP: In Guinea, it is estimated that 50% of maternal deaths resulted from complications arising from illegal abortions. Two hospital surveys were conducted in Deen and Donka, Conakry, respectively, to determine the prevalence of complications related to illegal or unsafe abortions and establish a proportion of adolescents within this high-risk group. The first study was prospective and covered the period of January-December 1992 and revealed 83 patients with complications resulting from illegal abortions, 31 (37.35%) of which were adolescent girls. Complications of induced abortion identified were infection (50%), hemorrhage (37%), and medicinal poisoning (12%). Out of the 83 patients, 10 died from complications. The second study was retrospective and covered the period 1990-93 and revealed 94 patients with complications associated with illegal abortion. Adolescent girls represented 31.9% of the cases, of which 80% were single and 40% were schoolgirls. The most frequent complications among adolescents were hemorrhage (50%) and infection (37%). The death rate was 20%. Proposed strategies to address this issue include: sex education, improving access of adolescents to family planning services, and establishing structures for the re-admission of girls who leave school due to pregnancy.^ieng

Sensitivity and specificity of routine antenatal screening for congenital anomalies by ultrasound: the Belgian Multicentric Study.

United States and European consensus views differ on the place of routine ultrasound scans during pregnancy and the validity of such scans as screening tests for fetal malformations in the general population is still under debate. Four ultrasound laboratories from Obstetric and Gynecology departments of Belgian University hospitals and affiliated hospitals have conducted a prospective study from 1984 to 1989 to compare the anomalies discovered in ultrasonic screening of the fetus with the anomalies of the neonates. Of 16,370 pregnant women at normal risk for congenital anomalies attending the antenatal clinics of these hospitals, 16,072 have had at least one ultrasound screening for congenital anomalies (98.5%). Congenital anomalies, single or multiple and 'minor' or 'major', were clearly defined in order to allow comparisons. The excluded congenital anomalies were listed as defined in the Eurocat Register. A total of 381 fetuses (2.3%) were structurally abnormal. Of the 381, 154 were correctly detected by ultrasound (sensitivity 40.4%). Altogether 15,972 fetuses were true negatives (specificity 99.9%). Eight (0.05%) were false positive for congenital anomalies. The positive predictive value was 95.1% and the negative predictive value was 98.6%. Ultrasound diagnoses were correctly achieved before 23 weeks of gestation for 21% of the anomalies. The gestational age, operator and technical dependence of ultrasound screening for congenital anomalies is discussed.

[Depot medroxyprogesterone acetate: clinical and metabolic effects (lipids, glucose, hemostasis)]. / Acétate de médroxyprogestérone-dépôt: effets cliniques et métaboliques (lipides, glucose, hémostase).

Medroxyprogesterone acetate (MPA), a potent progestagen, is used as a very efficient contraceptive agent. The method of administration is by a threemonthly or sixmonthly intramuscular injection. The method is particularly convenient when the desired number of children has been reached. Fertility is sometimes reestablished only slowly after stopping the injections. The main side effects are linked to endometrial atrophy (blood loss, amenorrhoea). Other side effects are infrequent and subjective. A controversy has risen over the product, by reference to its effects on beagle dogs. We have reviewed the literature. We also present the characteristics of 313 patients treated during (all together) 8,000 months. These patients belong to a rather poor sample of the population (amongst them many immigrant women), aged about 30, with above average pregnancy and parity rates. We also studied, in 31 patients, serum levels of glucose and lipids, and haemostasis. Side effects and reasons for discontinuing the drug are reported. The Pearl index was 0,75% women-years. There was no average effect on weight, blood tension, glycemia. Triglycerides increased slightly, and there was a discreet activation of coagulation with inhibition of the fibrinolytic activity, but without clinical consequences. We conclude that we can go on prescribing the drug, in view of our study and after reviewing the literature.