[Evolution of Uterine Ruptures at the Maternity of Ignace Deen National Hospital (Chu of Conakry)]. / Évolution des Ruptures Utérines à la Maternité de L'hôpital National Ignace Deen (Chu de Conakry).

Uterine rupture is a common obstetrical drama in our delivery rooms that has become exceptional in developed countries. In developing countries including Guinea, this tragedy is one of the major concerns of the obstetrician. The objectives of this work were: to evaluate the frequency of uterine rupture in the department, to describe the socio-demographic and clinical characteristics of the patients, to identify the factors favoring the occurrence of uterine rupture, to evaluate the maternal-fetal prognosis and propose a prevention strategy to reduce maternal and fetal morbidity and mortality by uterine rupture. This was a descriptive study with data collection in two phases, one retrospective lasting 18 months from July 1, 2017 to December 31, 2018 and the other prospective, lasting 18 months also from January 1, 2019 to June 30, 2020 both carried out at the maternity ward of the Ignace Deen National Hospital. We collected 84 cases of uterine rupture out of 18,790 deliveries, i.e. a frequency of 0.44%. During the same time 10,067 cesarean sections were realized, i.e. one laparotomy for uterine rupture for 120 cesarean sections. The average age of the patients was 28.14 years with a standard deviation of 2 years and the average profile is that of a housewife (51.8%), multiparous (44.6%), evacuated from peripheral maternity (85.5%) and having an insufficient number of antenatal consultations (82.6%). In 93.1% of cases, the uterine rupture had occurred in delivery centers, peripheral maternity hospitals and on the way, the uterine ruptures were mostly spontaneous (65.1%), and occurred in a healthy uterus (59.0%). Uterine rupture was more frequently complete (83.33%). Surgical treatment was more frequently conservative with hysterorrhaphy (88.1%). We recorded 12 maternal deaths, i.e. a case fatality rate of 14.6%. On admission, almost all of the women showed no signs of fetal life. To reduce the frequency of uterine ruptures, better organization of emergency obstetric and neonatal care and better screening for risk factors for obstructed labor during prenatal consultations should be encouraged.

[Socio-Anthropological Determinants of the High Prevalence of Obstetric Fistula in Guinea]. / Déterminants Socio-Anthropologiques de la Prévalence Élevée des Fistules Obstétricales en Guinée.

Objective: The purpose of this study was to analyse the socio-anthropological determinants (representations, beliefs, practices and perceptions of health services) of the high prevalence of obstetric fistulas in Guinea. Patients and methods: From January 15 to February 15, 2018, we carried out a qualitative study in three health centres (one urban and two rural). The study focused on biological mothers who attended the centres to get vaccinated their children. The data were collected by semi-structured individual interview. Results: None of the 42 respondents could link the occurrence of obstetric fistulas and obstructed labour. Participants at all three study sites believed that obstructed labour and obstetric fistula have a mystical origin. In Kissidougou, the respondents thought that obstructed labour and obstetric fistulas are caused either by soubaya, sorcery in Malinké or the evil spell korte in Malinké cast by an enemy, or the bad behaviour of the parturient which means either she practices adultery or if she behaves disrespectfully towards elders. In Dubréka, the respondents linked the occurrence of labour dystocia and obstetric fistula to witchcraft koromikhi in Sousou. In Labé, some respondents thought that obstructed labour and obstetric fistula are due to divine punishment in local dialect lette Allah when the woman does not respect her husband or has contracted the pregnancy out of the legal union. Others deemed that childbirth is difficult because of the narrowness of the delivery route in Fulani lawol ngol no faadhi in parturients who do not have sex during pregnancy or when the woman had not adequately had female circumcision, in local dialect o suuwaaki laabhi which means, part of the clitoris was left in place during the excision. The majority of respondents had a poor perception of health services (male staff, lack of privacy, poor hygiene, abuse). Several cultural practices (early wedlocks, genital mutilations, dietary restrictions, home deliveries) also induce obstetric fistulas. Conclusion: Respondents' cultural beliefs and practices regarding childbirth limit women's attendance at maternity hospitals during childbirth and favour obstetric fistulas.