Implementation of laparoscopy surgery training via simulation in a low-income country.

OBJECTIVE: The objective of this study was to evaluate laparoscopy training using pelvitrainers for gynaecological surgeons in a low-income country. METHODS: The study was carried out in Madagascar from April 2016 to January 2017. The participants were gynaecological surgeons who had not previously performed laparoscopy. Each surgeon was timed to evaluate the execution times of four proposed exercises, based on the fundamentals of laparoscopic surgery (FLS) programme's skills manual, as follows: exercise 1, involving a simple object transfer; exercises 2 and 3, comprising complex object transfers; and exercise 4, a precision cutting exercise. The 8-month training and evaluation programme was divided into different stages, and the four following evaluations were compared: a pretest (T0), assessment at the end of the first training (T1) and auto-evaluation at 2 months (T2) and 8 months (T3). RESULTS: Eight participants were included. The median time was significantly reduced (P<0.05) at each evaluation for exercises 1, 2 and 4 compared to the pretest. For exercise 3, there was no difference between T0 and T1 (P=0.07). After 8 months of training, all participants progressed in all exercises. CONCLUSION: Our study showed that it is possible and beneficial to develop a programme for teaching laparoscopic surgery in low-income countries before providing the necessary equipment.

Les déterminants de la fausse couche spontanée précoce

Objectifs : Cette étude vise à identifier les facteurs déterminants de la survenue d'une fausse couche spontanée précoce.Patients et méthodes : Il s'agit d'une étude cas-témoins effectuée à l'Hôpital Universitaire de Gynécologie Obstétrique de Befelatanana (HUGOB) (Antananarivo). Les cas sont constitués par toutes les femmes présentant une fausse couche spontanée précoce avec test de grossesse positif et les témoins sont constitués par des femmes ayant accouché.Résultats : Cette étude a permis de répertorier 75 cas et 150 témoins. La survenue d'une fausse couche spontanée précoce est déterminée significativement par la l'antécédent de fausse couche spontanée (OR = 2,31 [1,23-4,33], les habitudes toxiques (OR = 3,05 [1,17-7,94]), quelques facteurs professionnels à savoir : l'exercice d'une profession demandant un effort physique à 100% (OR = 2,68 [1,42-5,05]), la longue durée de travail dans la journée (> 8 heures) (OR = 3,08 [1,64-5,8]), le nombre de jour de travail dans la semaine (> 5 jours) (OR = 1,79 [0,95-3,38]), la position assise durant le travail (OR = 2,71 [0,97-4,88]).Conclusion : L'encouragement des femmes enceintes à réaliser régulièrement les consultations prénatales et l'amélioration des conditions de travail des femmes enceintes sont nécessaires pour diminuer les risques de la fausse couche spontanée précoce

[Adverse prognostic factors for preeclampsia in Madagascar]. / Facteurs de mauvais pronostic en cas de pré-éclampsie à Madagascar.

INTRODUCTION: Hypertensive disorders of pregnancy are serious diseases that cause high rates of maternal and fetal morbidity and mortality. Our goal was to determine the epidemiological, clinical, and laboratory findings associated with complications in these patients after the onset of hypertension. METHODS: This retrospective analytical study examined the files of women with hypertension who delivered at the Hospital of Gynecology Obstetrics in Befelatanana, Madagascar, in 2008-2010. RESULTS: During this four-year study period, 1320 women giving birth at our center had been hypertensive during pregnancy, for a prevalence of 5.11%; 409 (30.98%) had preeclampsia. The main maternal complications were eclampsia (14.46%), renal failure (3.40%), maternal death (3.03%), and placental abruption (2.95%). For the fetus, maternal preeclampsia was complicated by preterm birth (35.07%), perinatal death (21.42%), perinatal asphyxia (14.50%), and fetal growth restriction (9.71%). Patients younger than 20 years were at the highest risk of eclampsia (RR 2.18, 95% CI [(1.83 to 3.75]). Primiparity and history of eclampsia or fetal growth restriction were risk factors for eclampsia. Hyperproteinuria and elevated serum creatinine concentrations were associated with adverse fetal outcome. Isolated hyperuricemia was not associated with outcome. CONCLUSION: When preeclampsia has been diagnosed, some aspects of obstetric history and impaired kidney function are poor prognostic factors that can require early emergency delivery.

[Profile and characteristics of pregnant adolescents in Madagascar]. / Profil et caractéristiques des adolescentes enceintes à Madagascar.

Madagascar's population is predominantly young: those under 15 years account for 45% of the total population, and their number is expected to double again by 2025. First pregnancies accelerate particularly between the ages of 15 and 19 years among Malagasy teens. It seemed essential to know the profile of pregnant adolescents receiving care at a level-2 maternity hospital in the capital so that care and social services can be adapted to meet their specific needs. We found that teenagers accounted for 16.04% of the admissions to this maternity ward. Although more than half had used contraception at some point (most often condoms), most had not planned and did not want this pregnancy. The overall fetal loss rate was 9.77%, and the rate of complicated induced abortions 4.23%. Nearly three quarters (73.15%) of the teens had regular prenatal care. The preterm delivery rate was 3.25%. Promoting reproductive health education and preventing teenage pregnancy are urgent public health policy priorities in Madagascar.

[Causes of in utero fetal deaths: 225 cases at Befelatanana Hospital, Madagascar]. / Étiologies de la mort fœtale in utero : à propos de 225 cas à l'hôpital de Befelatanana Madagascar.

INTRODUCTION: The high rate of in utero fetal death in our hospital led us to study its risk factors and causes. METHODS: We conducted a case-control study from 1 January to 30 June, 2011, of all fetal deaths in utero in the Gynecology-Obstetrics University Hospital of Befelatanana. Risk factors were studied after comparison with a random sample of live births during the same period. The causes were classified according to the Perinatal Death Classification of the Perinatal Society of Australia and New Zealand. RESULTS: The rate of in utero fetal deaths was 5.22%. The risk factors statistically verified were: mother older than 34 years, parity of five or more, preterm, fewer than four prenatal consultations, previous fetal loss or hypertension disorders, and mother working in agriculture or commerce. The causes identified were hypertensive disorders (20.66%), prepartum hemorrhage (18.18%), fetal growth restriction (14.87%), premature rupture of the membrane (14.05%), hypoxia (12.39%), perinatal infection (11.57%), maternal conditions (3.30%), congenital abnormalities (3.30%), and specific perinatal conditions (1.65%). CONCLUSION: Screening for risk factors and close monitoring during pregnancy and labor are important to reduce fetal deaths.