Bilan des activités d'Anesthésie au service de Gynécologie - Obstétrique du Centre de Santé Gaspard Kamara, Dakar (Sénégal)

Objectifs : Faire le bilan des activités d'anesthésie au Centre de Santé Gaspard Kamara et proposer des recommandations pour améliorer la qualité des soins.Patientes et méthodes :Il s'agissait d'une étude rétrospective, descriptive et analytique allant du 1er Janvier au 31 Décembre 2012 et incluant toutes les patientes ayant bénéficié d'une anesthésie et dont les dossiers étaient retrouvés et exploitables. Le personnel du service d'Anesthésie-Réanimation était composé d'un médecin anesthésiste ­ réanimateur et de 5 techniciens supérieurs d'anesthésie dont 3 vacataires à temps partiel. Les paramètres étudiés étaient le profil épidémiologique des patientes, l'indication de l'anesthésie, les données de la consultation pré anesthésique, l'anesthésie peropératoire, la prise en charge postopératoire, les complications et les facteurs influençant le choix de l'anesthésie. L'exploitation statistique des données était effectuée à l'aide du logiciel SPSS version 20.0.Résultats : Durant la période d'étude, nous avons pris en charge 5147 patientes. Parmi celles-ci, 1256 ont bénéficié d'une anesthésie, soit un taux de 24,4%. Nous avons exploité 1033 dossiers (82,2%) qui répondaient aux critères d'inclusion. Le profil épidémiologique était celui d'une femme âgée en moyenne de 28 ans, primipare (50,4%), avec une parité moyenne de 2 et ayant déjà bénéficié d'une anesthésie. Près de la moitié des patientes (46,7%) étaient classées ASA 1. La césarienne était l'indication d'anesthésie la plus fréquente (91,2%) et la majorité des interventions étaient pratiquées dans un contexte d'urgence (87%). L'anesthésie peropératoire était réalisée par les techniciens supérieurs d'anesthésie dans 95,8% des cas. La rachianesthésie était la technique la plus pratiquée (86,9%). L'analgésie postopératoire associait le plus souvent le paracétamol au tramadol (76,8%). Des complications peropératoires étaient dominées par l'hypotension artérielle (10,8%). Un seul décès (0,1%) était enregistré et il n'était pas directement lié à l'anesthésie.Conclusion : La pratique de l'anesthésie est fréquente en Gynécologie Obstétrique. La faible incidence des complications observées dans notre série ne doit pas masquer les difficultés rencontrées au quotidien dans notre pratique. Pour améliorer la qualité des soins en anesthésie, nous devons augmenter l'effectif des ressources humaines qualifiées en anesthésie-réanimation et relever le plateau technique

[Thinking about the evolution of caesarean section rate at University Teaching Hospital of Dakar between 1992 and 2001]. / Réflexions sur l'évolution des taux de césarienne en milieu africain : exemple du CHU de Dakar entre 1992 et 2001.

OBJECTIVE: The objective of this study is to answer the question: have we not been doing a lot of caesarean sections at University Teaching Hospital of Dakar? PATIENTS AND METHOD: This is an analytic study about caesarean section in 1992, 1996 and 2001; it was a prospective and longitudinal data collection from the epidemiological survey program carried through in Senegal about its obstetrical and surgical cover. For each year concerned, we have analysed caesarean section rate, maternal mortality rate and perinatal mortality rate. To eliminate the random part in observed variation, we used the comparison of proportions observed as a statistical test with a significant threshold less or equal to 5%. RESULTS: Caesarean section has gone from 12% in 1992 to 17.5 in 1996 and 25.2% in 2001. Operative indications are dominated by foeto-pelvic disproportion with an average of 31% and foetal suffering with an average of 25%. The increasing trend has been statistically significant for information's such as foeto-pelvic disproportion and maternal pathologies. The falling trend was statistically significant for indications in relation on relation to foetal suffering and scarred uterus. Gathering information has shown a stabilisation of "obligatory" caesarean rate around 41%, a decrease in "caution" caesarean rate from 50 to 37.2% and an increase in caesarean by "necessity" from 8.6 to 22.4%. The maternal mortality rate among women delivered has fallen from 1.4% to 0.8%, but postoperative surgery morbidity rate was still high around 10%, essentially due to infections. Reading of caesarean section rate has not a significant impact in perinatal prognosis. DISCUSSION AND CONCLUSION: Today there is an inflation of caesarean section at University Teaching Hospital of Dakar, without any significant loss of the maternal and perinatal mortality rate. The high level of complications due to surgery incite to reverse trends in order to get reasonable rate around 10 to 15% of childbirths.

[Epidemiology and prognosis of caesarean sections in University Hospital of Dakar]. / Epidémiologie et pronostic des césariennes au CHU de Dakar.

Caesarean section is our first activity in obstetrical surgery. Due to his high frequency and the maternal and foetal prognostic, we have undertaken to do a prospective, longitudinal, exhaustive study concerning all women whose delivery necessitated a caesarean section, between 01 January and 31 December 2001 in Gynaecological and Obstetrical Clinic of University Hospital Center Le Dantec. Our objectives were: describe the epidemiological aspects, evaluate the maternal and foetal prognosis of caesarean sections performed in University Hospital Center. The study revealed that 25.1% of births necessitated a caesarean section. The average age was of 26; the mean parity of 2; the medium height of 161cm. 26.4% of patients were evacuated and coming from the health centers in majority (41.9%) with unmedicalised evacuation in 44.9% of cases. 78.7% of patients have realised at least 3 antenatal consultations. The mains indications were cephalopelvic disproportions (34.9%) and foetal distress (18.9%). The classification per indications group revealed that 37.2% were "prudence caesarean section", 40.1% were "obligator's caesarean section" and 22.7% "necessity's caesarean section". The mean Apgar's score at the birth was 6,5 at first minute. 12 maternal deaths were noted, means 0.8% of global lethality; the morbidity was at 10.5% of cases, represented mainly by postoperative infection (64.3%). The per natal mortality was estimated to 5.9% and neonatal morbidity to 32%. About the quality of caesarean sections, the temporal (24h/24) and financial(kit of caesarean section) accessibilities are more satisfying; otherwise the quality of surgical act and the postoperative follow-up was not optimal. An inflationist advancement is actually noted about the rate of caesarean section, and due to the widening of the indications to the foetal interest. Nevertheless, despite agreed efforts, the quality is still insufficient because the maternal and per natal morbidity and mortality are still high.

[Comparison of two cesarean techniques: classic versus Misgav Ladach cesarean]. / Comparaison de deux techniques de césarienne: césarienne classique versus césarienne Misgav Ladach.

OBJECTIVE: The aim of the study was to compare two cesarean section techniques Methodology. A prospective study was conducted UB 400 cesareans performed at the Gynecological and Obstetric Clinic of the Dakar Teaching Hospital between March 2000 and August 2000. Two hundred patients underwent the classical procedure (CL group) and the other 200 the Misgav Ladach procedure (ML group). Per- and post-operative data were compared between the two groups with Student's test and the Chi(2) test. A p-value less than 0.05 was considered statistically significant. RESULTS: The two groups were similar for socio-demographic and clinical data. The delay between the skin incision and infant delivery was significantly shorter in the ML group (5 minutes 26 seconds versus 6 minutes 20 seconds). The same trend was found for the length of operation (36 minutes 36 seconds versus 54 minutes 38 seconds). Fewer sutures were used in the ML group (2.92 versus 4.14). There is no significant difference for dose of analgesia, post-operative complications and hospital discharge. Cost analysis demonstrated that the Misgav Ladach procedure was 10000 FCFA (15 euros) less costly. CONCLUSION: Misgav Ladach method is simple, rapid, cost-effective cesarean procedure which appears to be an attractive alternative to traditional cesarean section.

[Fertility after ectopic pregnancy at the University Hospital in Dakar]. / Fertilité après grossesse extra-utérine au CHU de Dakar.

The aims is to evaluate fertility and medical cost about post ectopic pregnancy follow up. It is about a retrospective and descriptive study about 337 patients who have the opportunity to get a salpingectomy for an ectopic pregnancy between 1989 and 1997 at Le Dantec Gynecological and Obstetrical Clinic. After the ectopic pregnancy cure, women are followed with contraception, just time before trying to obtain another pregnancy. The studied parameters are: age, parity, socio-economical status, level of instruction, obstetrical and gynecological antecedents, Chlamydia serology, hysterosaipingography data, fertility after ectopic pregnancy, fees related to the cost of follow up after ectopic pregnancy. Data exploitation is done through an epidemiologic programme named Epi Info version 5 The average age of the patients was 27 years and that of the parity was 2.70. 87.83% of women were married. More than the half of those patients came from the suburb of Dakar. 171 patients (50.74%) were followed regularly, the other 166 (49.26%) disappeared. A Chlamydia trachomatis infection was found among 23.4% of cases. A tubal obstruction was noted in the level of the horns at 12.5 % of women. No case of maternal death was observed. Among 59 patients who wished a pregnancy, 34 ectopic pregnancy had been obtained (57.62%) in 4 month after stopping contraception and 26 cases of a new ectopic pregnancy. The expenses of medical cure after ectopic pregnancy are about 17.814 to 71,574.65 F CFA with an average of 38,689 F CFA (389.89 FF). Medical care after ectopic pregnancy raises a lot of problems: --some patients disappeared probably because of the inaccessibility of financial cost, --the high rate of Chlamydial trachomatis infection, an hypofertility after ectopic pregnancy. To combat this, we have to insist in the prevention of sexually transmitted diseases in general and of the chlamydial infection in particular. We have also to insist in the early diagnosis of the ectopic pregnancy. At last, we must set up a registre of ectopic pregnancy at the national level.

[Use of the male condom at schools and universities: survey with 1065 young people]. / Utilisation du condom masculin en milieu scolaire et estudiantin: à propos d'une enquete portant sur 1065 jeunes.

From February 25th to June 28th of 1999, the authors carried out a prospective and descriptive study of the use of the preventive male condom in schools and universities through an anonymous inquiry questionary dealing with 1065 persons involving 650 boy students, 181 girl students, 128 college boys and 106 college girls. The questionnary involved 5 headings: the socio-demographic characteristics, the use of condoms, the sources of information and supply, the number of partners, and information about the prices. The inquiry essentially let out that: 56.4% of target population used the male condom. Boys used condoms more often than girls. Most of the boys who used condoms were unmarried. Young people used condoms for preventive purpose against STD/AIDS and for contraception in 82.5 cases. The reason more oftenly given by those who didn't like condoms was the reduction of the sexual delight. The mature age and highest level of instruction were factors predicting the use of condoms. About 2/3 of the information sources on condoms were from media. The drugstore was the main source of supply. More than half of the users wished an extension of the Condom commercialization. The problems of acceptability and access to condoms related more of religions and socio-cultural order than geographical and financial.

[Uterine rupture in Senegal. Epidemiology and quality of management]. / Rupture utérine au Sénégal. Epidémiologie et qualité de la prise en charge.

The purpose of this prospective longitudinal study was to analyze data concerning patients treated for uterine rupture at surgical maternity hospitals in Senegal between January 1 to December 31, 1996. A total of 50 cases of uterine ruptures were recorded during the study period, i.e., 1 rupture for every 45 cesarian sections. Typical epidemiological features were rural residence (68%), age over 30 years (66%), multiparity (64%), and presence of obstetrical risks factors (76%). In 96% of cases, rupture usually occurred after failure or natural delivery assisted by personnel with limited skills in non-surgical facilities. Treatment consisted of uterine suture in 22% of cases and obstetrical hysterectomy in 78%. As a result of poor facilities for emergency transportation (68% of cases), mean delay between the indication for operative treatment and intervention was 11 hours. Maternal mortality and morbidity were 16% and 14% respectively. Neonatal mortality was 95%. The incidence of uterine rupture could be lowered by improving emergency obstetrical care and identifying risk factors for dystocia during prenatal examinations.

[Uterine rupture in Senegal. Results of 2 surveys taken in 1992 and 1996]. / Ruptures utérines au Sénégal. Résultats de deux enquêtes effectuées en 1992 et 1996.

OBJECTIVES: National prospective descriptive study on dystocia were conducted in Senegal in 1992 and 1996. We examined more closely the data on uterine rupture to determine trends between these two surveys. METHODS: Data were collected for all patients undergoing an obstetrical intervention between January 1st and December 31st in 1992 and in 1996 in one of the referral maternity-obstetrical surgery units in each of the 10 regions in Senegal. RESULTS: The rate of uterine rupture was 1 per 51 interventions in 1992 (1.87%) versus 1 per 53 interventions in 1996 (1.94%). This dramatic event was recurrent in 7 of the 10 regions. The patients involved were aged 25-35 years (68% in 1992 versus 70% in 1996), multiparous or grand multiparous (52% in 1992 versus 70% in 1996), illiterate (90%), with poor follow-up (less than 3 prenatal consultations in 56% of the cases), and were generally evacuated to the unit (80% in 1992 versus 97% in 1996) without medical care (55%). Maternal mortality was high (28% in 1992 versus 12% in 1996). Infant mortality was also very high (98% in 1992 versus 86.6% in 1996). Conservative treatment of uterine rupture was used increasingly: the rate of conservative suture rose from 3.3% in 1992 to 22% in 1996. CONCLUSION: Prevention is a challenge for healthcare workers, public authorities and the population in general. Health policy should be directed towards forming general practitioners in obstetrical surgery. Emergency surgery kits should be made available to improve the quality of care in all maternity units throughout the country.

[Peripartum idiopathic myocardiopathy: prospective echocardiographic study]. / La myocardiopathie idiopathique du péripartum: étude prospective échocardiographique.

Still frequent in Africa, the idiopathic peripartum cardiomyopathy (PPC) is the subject of only few prospective studies. The aim of this prospective work was to assess the echocardiographic abnormalities of the PPC and to determine on 26 patients the evolution and the prognostic factors of this disease. Six women had mild to moderate pericardial effusion. The abnormalities of the wall motion, constantly found, were diffuse in 20 cases (77.1%) and localized or prevalent on the interventricular septum or the left ventricular posterior wall in the other cases. The cardiac chambers were dilated in 24 cases (92.3%). Left ventricular hypertrophy was noted among 16 patients (61.5%); it was eccentric in 15 cases. The left ventricular systolic dysfunction was constant. The other abnormalities were: the abnormal left ventricular relaxation (one case), low mitral and aortic flow (12 cases), the mitral (21 cases) and tricuspid regurgitation (five cases). One noted a septal hypertrophy and an isolated dilatation of the right ventricle. The mean follow-up was 7.3 +/- 1 month (1-18 months). Two patients died at the 4th and 8th month. Among the 24 survivors, 11 had normalized were: the gestity (p = 0.01), the parity (p = 0.01), the cardiothoracic ratio (p = 0.04), the left ventricular volumes (p = 0.02), and the parameters of left ventricular function. The echocardiography of patients with PPC usually shows a pattern of dilated and hypokinetic cardiomyopathy, but many variations are possible. Most of the patients keep echocardiographic abnormalities after mean term follow-up.

[Prevention of infection in a surgical environment in the regional hospitals of Senegal]. / Prévention de l'infection en milieu chirurgical dans les hôpitaux régionaux de Sénégal.

This study evaluated the attitudes and practices of the personnel with respect to the prevention of nosocomial infections in a hospital environment. We carried out a qualitative survey of all categories of personnel between July 1998 and March 1999, at the five regional hospitals in Senegal (Thiés, Kaolack, Saint-Louis, Diourbel, and Louga). Data were collected in two ways: using a questionnaire to evaluate knowledge and by observing the attitudes and practices of the personnel. Hands were rarely washed before and after each procedure and surgical washing was often performed in poor conditions. The decontamination of soiled equipment was ineffective. Reusable instruments were washed directly with bare hands or by individuals wearing used surgical gloves. The equipment used for sterilization was dilapidated and unsuitable and the norms for sterilization were seldom respected. Circulation in the region of the operating theatre was disorganized, if not anarchic. The personnel had a high risk of contamination from blood. Biomedical waste was not decontaminated: it was collected poorly and disposed of directly into the environment. None of the sites visited had a program of waste incineration. In conclusion, at the sites visited, there is a high risk of nosocomial contamination during care and the reuse of equipment, for both the staff and the patients treated.

[Value of post coital and cytological sperm tests in conjugal sterility in Senegal]. / Intérêt des tests post-coitaux et cyto-spermiologiques dans l'exploration de la stérilite conjugale au Sénégal.

Conjugal infertility in Senegal is surrounded with accusatory believes most oftenly unfavourable to woman who is generally incriminated and, in somes cases, repudied. This study is an account of a research work carried out on conjugal infertility causes analysis, using post coital and cytospermiologic tests. It aims to help our populations to better appreciate the conjugal infertility by giving them elements for an objective appraisal of this flail, particulary about the mutual responsabilities of the two partners. In a first stage, we run post coital tests with 4636 Negro-African infertile couples living in Senegal, at the Clinical Cytology, Cytogenetics, and Reproductive Biology Laboratory of Aristide Le Dantec Hospital in a period dated from 1983 to 1996. Post coital tests were abnormal for 3838 couples and 3150 of them had anomalies incriminating the husbands. In a second stage, post coital tests were suggested to these 3150 husbands, but only 2842 accepted the post coital test suggestion. The others refused it for sociocultural reasons. It stooks out of this study that: the responsability in the conjugal sterility is mixed and shared by both partners in 43.78% cases, the masculine responsability (38.30%) ruled the feminine one (17.92%) contrary to local believes, almost one husband out of four (23.89%) presented azoospermy, the feminine responsability is ruled by infection factors that represented half of the glair abnormalities (50%). These results contradict the present local mentalities and believes which accuse principally the woman.

[Uterine perforation after an illegal abortion]. / Perforation utérine après avortement provoqué.

This study focuses on problems related to the management of peritonitis following non-medically assisted abortions in developing countries. Between January 1, 1997 and December 31, 1998, four cases of peritonitis due to perforation of the uterus occurred in a consecutive series of 101 women treated following non-medically assisted abortions at the Gynecology and Obstetrics Clinic of the University Hospital Center in Dakar, Senegal. Abortions were performed by untrained persons using dangerous instruments (wood or metal probes) for prices ranging from 5000 to 30,000 CFA francs. The mean interval between abortion and hospitalization was seven days. All patients presented in poor condition with low-grade symptoms of peritonitis. In 3 of 4 cases, the site of perforation was located in the isthmus (anterior, posterior, and lateral). Extensive necrotic lesions required hysterectomy. Postoperative complications occurred in 3 cases including parietal infection in one case, repeat peritonitis requiring re-operation in one case, and fatal iliomesenteric infarction in one case. Prevention could best be achieved by reducing unwanted pregnancies by better sex education and access to contraceptive techniques.

[Cesarean sections in Senegal: coverage of needs and quality of services]. / Césariennes au Sénégal: couverture des besoins et qualité des services.

A prospective longitudinal study was carried out of all women undergoing Cesarean section in the surgical maternity hospitals of Senegal between January 1 and December 31 1996. The epidemiology and quality of Cesarean sections were investigated. For each case, the following data were recorded: marital status, prenatal monitoring, conditions of hospitalization, indications for and outcome of surgery, maternal and neonatal follow-up one month after the operation. 2,436 Cesarean sections were performed. Of these, 2,269 cases were indexed and filed and 1,612 received a postnatal checkup one month after the operation. The mean age of the women involved was 26 years. The referral system is not effective, with 58% of patients being rushed to a surgical maternity unit in medically unsuitable forms of transport. Cesarean section is not widely available either geographically or economically. The mean national rate of Cesarean section was 0.6% of expected births but there were differences between regions. The main indications for Cesarean section were the fetus being too large to pass through the pelvic girdle (30%) and fetal suffering (18%). The maternal mortality rate was 3% and one third of the women who died did so immediately after the operation. Maternal morbidity occurred in 10% of cases, mainly due to postoperative infection. The rate of perinatal stress was 25%, most deaths being caused by neonatal distress (33%) or infection (18%). Thus, overall, both the availability and quality of Cesarean section in Senegal are poor.

PIP: A prospective study was conducted of all women delivering by cesarean section in Senegal's 22 surgical maternity hospitals during 1996. Adequate data were available to include 2269 of the 2436 cesareans performed. 13 hospitals performing 55% of the cesareans were in the Dakar area. Two of Senegal's 9 regions had no surgical maternity hospital and 4 had no gynecologists. 19.5% of the mothers were adolescents, and the average maternal age was 26 years. 46.5% were primiparous. 64% of the mothers were urban. 65% had at least 3 prenatal consultations and 12% had none. Only 28% were referred for cesareans before the onset of labor, and 57% were emergency evacuations. 6.7% of the women had to be re-evacuated from supposedly ultimate referral hospitals due to lack of supplies or personnel. 41% were transported to the hospital in ambulances, 14% in private cars, and 44% by public transportation. The 2436 cesareans corresponded to a rate of 0.6% of expected births, only 20% of the minimum need for cesareans estimated at 3%. Regional cesarean rates ranged from 1.3% in Dakar to 0.1% in Kaolack-Fatick. Feto-pelvic disproportion (30.4%) and fetal distress (18.2%) were the most common indications. 73 maternal deaths occurred, for a rate of 3%. 10% of the women had complications, with 55% involving infection. There were 9 cases of vesicovaginal fistula. The perinatal mortality rate was 25%, with 13% intrapartum and 13% neonatal. Neonatal distress and infection were the main causes of early neonatal death. Accessibility of cesareans is poor both geographically and economically.

[Pregnancy after tubal sterilization. Experience at the University Hospital Center of Dakar]. / Grossesse après stérilisation tubaire. Expérience du CHU de Dakar.

Between January 1991 and December 1996, 856 women had a tubal sterilization by minilaparotomy under local anesthesia in obstetric and gynaecologic clinic of University Teaching Hospital of Dakar. Among her 5 became pregnant after 7 to 54 months (mean 19 months). The failure rate is 5.84 per 1,000; all 5 women had intra-uterine pregnancy. The women were age 35-43 years (mean 38 years) and multiparity with 8 children. The main causes of failure was technical error and tubal peritoneal fistula. Favorables factors has been represented by inexperience of surgeons and also per-operations difficulties particularly dues to strucked fallopian tubes. 4 has delivered a healthy child with one by cesarean section, in 3 cases she decided to be sterilized again after delivery.

[Emergency obstetrical hysterectomy]. / L'hystérectomie obstétricale d'urgence.

Hysterectomy on pregnant uterus is a mutilating procedure used by obstetrician only when he haven't choice in case of major complications of pregnancy or delivery. This retrospective study worked on 35 cases of obstetrical hysterectomy performed on 22 months period (January 94-October 95). The frequency of the procedure among all the in hospital deliveries was 0.45%. The mean age of the patients was 31 years, and the mean parity was 7. 77.5% of the women were referred from over surrounding hospitals where natural deliveries had failed. We performed the hysterectomy because of uncontrolled haemorrhage in 71.7%, and infection in 25.8%. Sub-total hysterectomy was performed in 82.8%. Maternal mortality was 20%. Hysterectomy is very mutilating, but is a life rescueing procedure behind a lifethreatening complication of pregnancy or delivery. The best strategy to prevent the necessity of hysterectomy, is to develop the early obstetrical reference program that unfortunately is not yet in practice in our health care system.

[Epidemiologic and obstetric aspects of adolescent pregnancies in the hospital milieu]. / Aspects épidémiologiques et obstétricaux de la gravidopuerpéralité des adolescentes en milieu hospitalier.

Adolescence is a period of change where the person is seeking an identity. This period is characterized by an early sexuality with early pregnancies and risky deliveries. The objectives of our study are to show the epidemiologic aspects of adolescent pregnancy and to identify its obstetrical factors. It is a prospective study held in one year, from August 1st 1991 to July 31 1992 including all pregnant adolescents and those coming for delivery at the Obstetrics and Gynecology clinic at the University teaching hospital Le Dantec. The prevalence of adolescent pregnancy is 3.7% and 84% are primiparous. The non-educated represent 65% and 55% are married. Early sexuality and early pregnancy are mostly seen among Pulars. The complications during pregnancy are toxemia and its accidents (17.6%), premature rupture of membrane (4.4%) and anemia (2.5%). Adolescent who had not received prenatal care represent 11% and 38% had not received enough care. Normal delivery happened in 67.5% and the C-section represented 7.5%. 3% of the adolescents had done unsafe abortion. No maternal death was observed. 89.1% live births were reported, however, 18.4% needed intensive care. Because of the obstetric and neonatal problems, early pregnancy should be prevented through a active collaboration of divers partners.

[Retroplacental hematoma at the Dakar University Hospital Center]. / L'hématome rétroplacentaire au CHU de Dakar.

Abruption placenta has been a principal cause of maternal mortality by hemorragy at Dakar University Teaching Hospital. The incidence is 2.44%. It related with multiparity and age. Etiologics factors such as toxemy (7.01%) and HTA (5.26%) were founded, lack of prenatal care was notified. The complete form is observed in 71.3% and bad hemodynamic conditions in 61%. The death rate is 8.4%: morbidity is dominate by anemia, renal failure and coagulation defect. Perinatal mortality is 87.07%. Cesareans were performed on only 2.25%. The amelioration of the prognostic is linked with depistage of women with high risk of abruption placenta, a good prenatal survey, an early diagnosis and quick evacuation of the uterus.

[Complications of tubal sterilization by minilaparotomy under local anesthesia]. / Complications de la stérilisation tubaire par minilaparotomie sous anesthésie locale.

Between January 1, 1991 and June 30, 1996, physicians performed 800 cases of tubal ligation via minilaparotomy under local anaesthesia in the Obstetrics and Gynecology clinic of the Dakar University Teaching Hospital (Senegal). There were complications in 7 (0.87%) cases (bladder and bowel injuries: 6 cases, and post operative infection: 1 case). The most frequent risk factors were: surgeon skill (lack of experience of surgeon in minilaparotomy), type of patients (obesity, previous abdominal surgery). It was concluded, proper training and experience of the surgical team is needed to minimize sterilization related complications.

PIP: Although only a small percentage of reproductive-aged women in Africa opt for sexual sterilization, it is the most widely used method of family planning worldwide. Most female sterilizations in Africa are performed using minilaparotomy under local anesthesia. While this approach offers benefits, especially when only inadequate equipment is available, it can also result in operation-related consequences. Results are presented from a retrospective study of records on 7 cases involving complications recorded at the Gynecological and Obstetrical Clinic of the University Hospital in Dakar in a series of 800 tubal ligations performed using minilaparotomy under local anesthesia between the beginning of January and the end of June 1996. The complication rate of 0.87% is comparable to that reported in the literature. There were 3 cases of bladder injury, 3 cases of bowel injury, and 1 case of post-operative infection. The injuries, of which the average length was 1.5 cm, were repaired immediately under general anesthesia. The tubal ligation was then performed. Main risk factors for complications were operator inexperience and the poor choice of candidates being obese and having histories of abdominal surgery. Despite the possibility of complications, tubal ligation through minilaparotomy under local anesthesia should be considered simple, safe, and affordable.