[Is pelvic clinical evaluation still relevant?]. / La pelvimetrie clinique est-elle encore d'actualite?

OBJECTIVES: Establish specificity, sensibility of clinical pelvimetry using X-ray pelvimetry as the reference exam; Assess reproducibility of clinical pelvimetry comparing two physicians' findings. PATIENTS AND METHODS: During a longitudinal study of 29 months, we compared clinical clinical pelvimetry findings of 114 patients with results of X-ray pelvimetry. Reproducibility was assessed comparing pelvic measures performed by two physicians for 40 patients. Based on caesarean ratio of 7% due to cephalopelvic disproportion in our department, the required size of sample was estimated between 114 and 200 patients. Statistics tests used were the independent test of Chi-2, the Kappa coefficient, the T-test and discriminant analyze. A p-value of 0.05 was considered as significant. RESULTS: The sensibility of clinical pelvimetry was found at 83.7%, specificity at 88.9%. Positive predictive value was 97.6% and negative predictive value founded at 50%. Best concordances were obtained for the measures of vertical diameter of Michaelis, Trillat diameter and assessment of sciatic spines and inominated lines. Clinical pelvimetry was reproducible with a kappa value of 0.62. CONCLUSION: Clinical pelvimetry, due to his good specificity and satisfactory reproducibility is still relevant in case of unavailability of X-ray pelvimetry as it happens in Africans ressourceless countries.

[Adolescent reproductive health in Senegal: situation and care strategies]. / Sante de la reproduction des adolescents au Senegal: situation et strategies de prise en charge.

INTRODUCTION: Adolescent reproductive health is a public health concern in Senegal because of early sexuality and fecondity and its consequences. The objectives of this study is to address key issues of adolescent reproductive health and interventions in order to give recommendations. MATERIAL AND METHODS: For this review article, data collection was performed from work carried out in Sénégal and related to adolescent reproductive health. Thus, aspects related to sexuality and its consequences in adolescent health have been studied. Also, interventions which address adolescent reproductive health have been highlighted. RESULTS: Adolescents represent the quater of the population in Senegal. They are faced with h ealth issues related to early pregnancies, unsafe abortion, sexually transmitted diseases and HIV infection. Despite these remarks, adolescents hardly use health services because of stigmatisation, shame, fear or because of health providers attitudes. Several interventions have been launched and implemented. They have included sensibilisation, information, education and services provision in structures specially reserved for adolescents and youth. CONCLUSION: Several research studies and interventions have been done in adolescent reproductive health. However, few of them have been published in peer review journals. During adolescence, continuous actions with an holistic approach should be taken to address adolescent health issues and development.

[Protein C, protein S and antithrombin III at normal delivery and during abruptio placentae]. / Protéine C, protéine S et antithrombine III à l'accouchement normal et au cours de l'hematome rétroplacentaire.

Protein C, Protein S and Antithrombin III were screened in one hundred patients admitted for abruptio placentae and one hundred women who delivered normally in Dakar university hospital. We found a reduction of Protein S at normal delivery which is linked to hypercoagulation activity during this process. PC and PS were significantly decreased during abruptio placentae in relation with the disseminated intravascular coagulation which was found in our study. We recommend to include these tests to explore aetiologies of abruptio placentae and to confirm their congenital deficit two months after delivery.

[Contraception by subcutaneous Norplant implants. 300 cases]. / Contraception par les implants sous-cutanés Norplant. A propos de 300 cas.

It is a prospective study for the evaluation of the efficiency and the acceptability of Norplant contraceptive subdermal implants within the Senegalese female population. Three hundred women were selected on the basis of precise criteria between December 1986 and July 1991. Every patient included in the study signed a form of voluntary consent with the agreement of the consort, and was bound to come to control examinations until the removal of the implants. The insertion was made under local anaesthesia between the 1st and the 7th day of the cycle, or starting from the 6th week of post-partum in the other cases. The average age of patients was 32, and the average parity four children. 50 percent of women did not want any other children. The average insertion time is 4.8 minutes. The analysis of side-effects on 248 regularly followed women mostly reveals menstrual troubles like amenorrhea, spottings, menorrhagia. The fitful local prurigo was noted in 35 cases, and accidental pregnancy in 4 cases. The removal of implants within the first six months was made on 11 women (4.4%). As such, the Norplant implants constitutes a highly efficient method, well tolerated by Senegalese women.

[Medical management of alleged sexual assault victims in Dakar, Senegal. 25 cases]. / Prise en charge médicale de victimes présumées d'agression sexuelle à Dakar, Sénégal. A propos de 25 cas.

Sexual assaults constitute a prominent fact of our societies to this end twentieth Century. Then its's very important for physicians to be informed about obstacles encoured to manage assaults victims. Our study presents 25 cases of sexual assaults listed in Obstetrics and Gynecology Clinics of University Center Hospital of Dakar. It works out that: there are adolescents in most cases (85%); delay of examination is too long (11 cases beyond 24 hours) and compromises cytologic exams; injuries evaluation is sometimes negative; no lesion of anal sodomy is found. The authors insist to provide more informations to physicians to overcome evaluation of assault victim which has an impact for legal proceeding against offender. They call gaps to fill up un senegalese jurisprudence about assault victim who gets an accidental pregnancy.

[Medical management of presumed sexual assault victims in Dakar, Senegal. Report of 25 cases]. / Prise en charge medicale de victimes presumees d'agression sexuelle a Dakar, Senegal. A propos de 25 cas.

PIP: Between January 1989 and June 1992, interviews with and a medical examination of 25 rape victims (mean age, 12 years; range, 7-21 years) were conducted at the University Hospital in Dakar, Senegal. Females aged less than 18 represented 84% of cases, 25% of whom were less than 10 years old. None were married. Sexual abuse occurred during ovulation among 5 of the 11 victims who had reached menses, thus placing them at risk of pregnancy. Places where the rapes occurred were the dwelling of either the offender or the victim (56%), especially that of the victim (9/14 cases), or a public place (44%). The victim knew the presumed offender in 80% of cases. Known offenders included fathers, priests, employers, ex-boyfriends, and men living in the vicinity. In five cases the female was gang-raped. 18 victims waited 72 hours before seeking care; 2 females waited 3 weeks. The long delays compromised cytologic exams and findings. None of the victims had ever had a child. One case had nine weeks of amenorrhea and tested positive for pregnancy. The only extragenital lesion was a bruise on the thigh. Genital lesions included bruises or lacerations of the large and small labia, lacerated hymen (sometimes ruptured hymen), fossa triangularis, and vaginal lacerations. There was no evidence of anal penetration. 3 of 15 samples tested positive for pathogens (1 for Escherichia coli; 2 for Candida albicans). Sperm was found in only 1 case. In 7 cases, penetration had not occurred, probably due to immature genitals. It was not clear whether penetration had occurred or not in 3 other cases. Penetration clearly occurred in 15 cases. Physicians and allied health personnel should be sensitive and prepared to perform a complete physical exam so as to defend the interests of the victim and of society by obtaining proof to convict the sexual offender. Senegalese jurisprudence does not consider the distress of rape victims with an unwanted pregnancy. Legislation should include rape as a reason for legal abortion.^ieng

La pelvimetrie clinique est-elle encore d'actualite ?

Objectifs : Etudier la specificite; la sensibilite de la pelvimetrie clinique en utilisant la scannopelvimetrie comme examen de reference ; Apprecier la reproductibilite de la pelvimetrie clinique. Patientes et methodes : Au cours d'une etude longitudinale pendant 29 mois; nous avons compare les resultats des mensurations cliniques du bassin chez 114 patientes a ceux de la scannopelvimetrie et pour 40 d'entre elles; deux cliniciens ont confronte leurs mensurations du bassin. Les tests statistiques utilises etaient le test du Chi-deux ou Chi-carre (Chi-2) d'independance accompagne du coefficient Kappa dans certains cas; le T-test et l'analyse discriminante. Le seuil critique que nous avons retenu pour ces tests etait un p = 0;05 Resultats: La sensibilite de la pelvimetrie clinique etait de 83;7et la specificite de de 88;9. La valeur predictive positive de notre examen est de 97;6; et la valeur predictive negative est de 50. La pelvietrie clinique etait reproductible avec un kappa statistique a 0;62. Conclusion : La pelvimetrie clinique; du fait de sa bonne specificite mais aussi de sa reproductibilite satisfaisante; garde encore toute sa valeur en cas d'inaccesibilite de la scannopelvimetrie comme c'est encore le cas dans la plupart des pays africains