[Haemostatic hysterectomies in developing countries: A vital act. Prospective study in a reference Nigerian maternity]. / Les hystérectomies d'hémostase en pays sous-équipé: un geste vital. Etude prospective dans une maternité de référence au Niger.

OBJECTIVE: The purpose of our prospective study was to determine the frequency, the main indications and difficulties of coverage of the peripartum haemostatic hysterectomy in a developing country. The secondary purpose was to assess the maternal forecast and suggest suited management and to estimate the necessary material and human means to reduce the incidence of this surgery. PATIENTS AND METHODS: We realized a forward-looking monocentric study in the Issaka Gazobi maternity of Niamey, between January 1st, 2003 and December 31st, 2003. RESULTS: 3255 deliveries took place, and 41 peripartum haemostatic hysterectomies for post-partum haemorrhage were realized (ie 1.26%). The mean age of our patients was 32.76. The multiparous (more than 5 children) were most often concerned. The majority of patients had benefited from an in utero transfer. 31 patients presented an active bleeding, 11 were in a state of shock during the admittance. The main indications of hysterectomies were represented by an abruptio haematoma, uterine inertia, a rupture of the uterus, a wound of the genital field, 1 placenta accreta with uterine inversion. In a third part of the cases a disseminated intravascular coagulation was associated to the clinical picture. The hysterectomy was subtotal in most of the cases. Finally, the rate of maternal death is high in our series. DISCUSSION AND CONCLUSION: Prevention of post-partum haemostatic haemorrhage and new therapeutic strategies are essential to reduce the rate of haemostatic hysterectomy in our regions, and improve the coverage of this pathology. However, it is a vital surgery which must be technically mastered.

[Management of ectopic pregnancy in developing countries: example of a Nigerian reference maternity]. / Prise en charge de la grossesse extra-utérine dans les pays en voie de développement: exemple d'une maternité de référence au Niger.

OBJECTIVE: We report 143 cases of ectopic pregnancy (EP) treated in the Issaka-Gazobi maternity of Niamey between January 1st, 1999 and April 30th, 2001 (28 months). The objective of this study was to estimate the epidemiological, diagnostic and therapeutic aspects to propose actions, which could lead to the improvement of the prognosis of EP. PATIENTS AND METHODS: The frequency of ectopic pregnancy was 2.32% in our study. The patients were young and pregnant for the second or third time. Frequently we observed previous sexually contagious infections and/or abortions. More than 70% of the patients were admitted for a complicated stage of EP. RESULTS: The culdocentesis allowed to evoke the diagnosis in more than 80% of the cases. It is a simple gesture, which makes it possible to make the diagnosis of EP and which should be taught and practised in maternities of the developing countries. The pelvic ultrasonography and the laparoscopy allowed the diagnosis in the other cases. The tubal localization was the most frequent, cervical and abdominal pregnancies were found. The surgical treatment conducted by laparotomy was conservative in 11.9% and radical in 87.4% of the cases. The mortality rate was still 0.70%. DISCUSSION AND CONCLUSION: Prevention of the sexually contagious infections and medical management of abortions are important to reduce the risks of ectopic pregnancies. Education of the patients, living far from the maternity, is also necessary to obtain more precocious consultation in case of pregnancy in order to improve the prognosis of EP.