HYSTEROSALPINGOGRAPHY AND LAPAROSCOPY IN EVALUATING FALLOPIAN TUBES IN THE MANAGEMENT OF INFERTILITY IN COTONOU, BENIN REPUBLIC.

INTRODUCTION: Hysterosalpingography, along with laparoscoy, are the most requested examinations for tubal factor exploration for infertility, in developing countries. OBJECTIVE: To compare the results of hysperosalpingography and laparoscopy in patients assessed for infertility. PATIENTS & METHODS: This was a 5 years retrospective, descriptive study done at the Obstetrics and Gynecology Clinic of the HKM Centre, National University Hospital. All the patients admitted for infertility of tubal origin were included. These included 96 patients who had undergone hysterosalpingography followed by laparoscopy. The analysis was done with the SPSS version 12.0.1. RESULT: The mean age of the patients was 33.3 years. Infertility was primary in 66.3% of cases and secondary in 33.7% of cases and the average duration was 48.9 months. Hysterosalpingography diagnosed 9.37% of proximal tubal obstruction while laparoscopy diagnosed same in 17.71%. Besides pelvic adhesive bands seen in 33.33% of cases, laparoscopy was able to visualize patent tubes with some pathology in 11.46%, and pelvic endometriosis in 6.25% of cases. CONCLUSION: The results of HSG and those of laparoscopy are complementary in tubal infertility evaluation. While HSG seems to be reliable when the tubes are patent, laparoscopy helps to reveal false tubal obstructions observed with HSG, and also helps in the diagnosis of pelvic adhesive bands and endometriosis.

[Effective management of hospital services in Benin]. / Une gestion managériale des structures hospitalières du Bénin.

Hospital services remain poorly managed in African countries and in particular in Benin. Effective management must promote strategic planning and implementation of resources to achieve desired goals. The purpose of this article is to describe elements contributing to the poor performance of health care facilities in Benin and more particularly the response of hospital management within the framework of ongoing reforms. Analysis also focuses on strategic priorities and the central role of the human factor in any action to organize management. Implementation of participative management in the Beninese hospitals still requires great improvement in numerous areas including integration of health facilities into an open system, reinforcement of continuous education programs for personnel, recruitment of qualified technical personnel, and creation of training modules in hospital management.

Une gestion manageriale des structures hospitalieres du Benin

La gestion des services hospitaliers reste un probleme dans les etats africains et plus particulierement au Benin. Elle doit etre un instrument d'aide a la definition des orientations strategiques et des dispositions a mettre en oeuvre pour les realiser. Cet article presente des elements de dysfonctionnement des etablissements de soins au Benin et plus particulierement la gestion hospitaliere au regard des reformes en cours. L'analyse aborde aussi les strategies prioritaires et l'importance du role central de l'element humain dans toute action d'organisation manageriale. Cette organisation de management participatif demande encore beaucoup d'efforts pour son application dans les hopitaux beninois; dont entre autres : la prise en compte de l'environnement des structures de sante dans un systeme ouvert; le renforcement de la formation continue des personnels; la dotation de personnel technique competent; la creation de modules de formation en gestion hospitaliere

[Influence of maternal weight on pregnancy outcome in Cotonou (Benin)]. / Influence du poids maternel sur l'évolution de la grossesse à Cotonou (Bénin).

To evaluate prevalence of obesity in pregnant women in Cotonou and to study the influence of obesity on pregnancy outcome, we analysed retrospectively obstetrical reports of 323 women delivered at the university clinic of gynecology and obstetrics during the year 1999. Prevalence of obesity was 18% among pregnant women and 30.6% of them were overweight. Medical complications of pregnancy were more frequent in obese women than in women with normal weight since obese women showed higher frequency of proteinuria (241% versus 10,5%, p<0.05) and high blood pressure (25.9% versus 4.5%, p<0.001). Diabetes mellitus was only present in obese women with a frequency of 5,2%. Compared with normal weight women, the obese ones showed a tendency to higher frequency of cesarean delivery (34.5% versus 21%), this difference being not statistically significant. Although there was a slightly higher number of reanimated infants in obese women, the difference was not significant. Six percent hypotrophic infants were observed in obese mothers versus 13.1% in mothers with normal weight (non significant) but it can be noticed that lean mothers showed statistically higher frequency of hypotrophic infants than normal weight mothers (33.3% versus 13.1%, p<0.01). This study shows that obesity in women represents, even in developing country, an obstetrical risk factor leading to high frequency of complications during pregnancy and needs the development of preventive actions.

[Types of hypertension in pregnant women of Benin admitted to the National University Hospital of Cotonou]. / Les différents types d'hypertension artérielle chez les femmes enceintes béninoises admises au CNHU de Cotonou.

We carried out a retrospective and prospective study between January 1995 and August 1996, of pregnant women with high blood pressure. The aim of this work was to determine the prevalence of each type of hypertension according to the classification of the American College of Obstetricians and Gynecologists (ACOG) and to evaluate the prognosis for the mother and child. The prevalence of hypertension in pregnancy was found to be 7.65%. A family history of hypertension, obesity and a personal history of hypertension in pregnancy were all risk factors. Severe hypertension (diastolic blood pressure (DBP) > 110 mm Hg) affected 59.4% of the women. Chronic hypertension occurred in 41.51% of cases, preeclampsia in 26.41% of cases, associated preeclampsia in 18.87% of cases and isolated hypertension in 13.21% of cases. Eclampsia (70.6%) was the principal maternal complication in this study population. Fifty-four of the women gave birth to normal babies, 21 to hypotrophic babies, 15 gave birth prematurely and 3 had miscarriages. Six of the seven deaths involved women with DBP above 110 mm Hg.

[Pregnancies complicated by hemorrhage and birth of low birth weight infants in Cotonou (Benin)]. / Grossesses compliquées d'hémorragie et naissances d'enfants de faible poids à Cotonou (Bénin).

The effect of bleeding during pregnancy on the outcome remains unclear. Nevertheless, some of these pregnancies go to term, raising the question of the effects on the new-born infant. The data concerning a possible correlation with low birth weight are ambiguous. Furthermore, there are few studies of this issue in developing countries. We studied 2168 women giving birth to single children chosen at random in two maternity services in Cotonou (Benin) in 1990. Data was collected by two trained midwives interviewing the women and from the medical files 24 hours after delivery. One hundred and thirty seven mothers (6.2%) reported bleeding during pregnancy. Multivariate statistical analysis indicated that this was associated with preterm birth of low birth weight infants: OR = 4.09 (2.2-7.6) for bleeding during the first trimester, OR = 2.29 (1.1-6.9) during the second and OR = 4.79 (2.1-11.9) during the third. Only bleeding during the third trimester correlated with a significant retardation of intrauterine growth [OR = 2.33 (1.4-7.3)] according to model fitting. Thus, despite possible bias in this retrospective study, bleeding during pregnancy appears to be a predictor of low birth weight in Cotonou (West Africa).

Séroprévalence de l'antigène HBs du virus de l'hépatite chez les femmes enceintes et leurs enfants

Une etude prospective a determine la seroprevalence de l'antigene HBs (AgHBs) du virus de l'hepatite B (VHB) chez les femmes enceintes et les enfants nes de meres seropositives. La technique utilisee etait l'Elisa; suivie de la confirmation par la methode de neutralisation. Sur 1;017 gestantes testees; 84 (8;26 pour cent) etaient porteuses de l'AgHBs. Parmi celles-ci; 40 avaient ete suivies et etaient restees seropositives apres l'accouchement. Sur les 40 enfants nes de ces dernieres; l'AgHbs etait detecte dans le sang chez 8 d'entre eux (20 pour cent) dans un delai de 1 jour a 11 mois apres la naissance

Les hémorragies de la délivrance: étude statistique et étiologie (à propos de 151 cas recenses en 5 ans)

Dans une etude portant sur les complications de la delivrance observees a la Clinique Universitaire de Gynecologie et d'Obstetrique du C.N.H.U. de Cotonou; les auteurs relevent un taux de 0;89 pour cent de cas d'hemorragies de la delivrance sur un total de 16 979 accouchements. Sur les 151 cas recenses le taux de mortalite est de 21;85 pour cent. L'etude des facteurs de risque realisee permet de proposer une attitude preventive plus active afin de reduire l'importance de ce fleau